Traumatic Posterior Urethral Disruptions in Boys: Experience With the Perineal/Perineal–Transpubic Approach in Ten Cases

Das, Kanishka; Charles, A. R.; Alladi, Anand; Rao, Subba; Cruz, A.J.D.’

doi:10.1016/s0022-5347(05)00103-5

Cited by 3 publications

(4 citation statements)

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“…In our present series, 11 boys had SUI, of which 10 became dry in a few months except for one boy who still has off and on daytime SUI at 2 years of follow-up. Das et al [15] and Singla et al [25] reported excellent continence results after perineal and transpubic urethroplasty. Podesta and Podesta [17] reported nine of 49 patients had UI after urethroplasty, six of them had SUI and one had total UI.…”

Section: Discussionmentioning

confidence: 98%

“…Patil [14] followed five of 30 patients for 7-10 years after transpubic urethroplasty and found all competent and continent. Das et al [15] operated on 10 children using transpubic approach with 100% success rate. Basiri et al [16] reported symphysiotomy in 10 children (both boys and girls); all were successful and continent without any complications.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of anastomotic urethroplasty in traumatic stricture (distraction defect) of posterior urethra in boys

Zafar¹,

Hayat²,

Amin³

et al. 2020

Arab Journal of Urology

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Objective To report the outcomes of operative management of traumatic posterior urethral distraction defect in boys at our Centre, as traumatic posterior urethral stricture in children is a rare condition that presents a major surgical challenge to the paediatric urologist and consensus on the optimal treatment of these strictures in children has not been reached. Patients and methods We retrospectively analysed our data from July 2013 to June 2018. All boys aged ≤16 years with traumatic posterior bulbo-prostatic obliteration (distraction defect) were included. Initial suprapubic cystostomy and delayed definite anastomotic urethroplasty was done in all the boys. The boys were evaluated preoperatively with a retrograde urethrogram and simultaneous voiding cystourethrogram, as well as cystourethroscopy. Results A total of 38 boys, with posterior urethral distraction defect, were divided into primary and redo surgery groups. The primary group comprised 34 boys who were operated upon for the first time. A perineal approach with development of an inter-crural space was done in 12 boys and along with an inferior pubectomy in 19 boys. Three boys in the primary group needed a transpubic approach due to a longer defect. In the redo group, there were six boys, of which four were operated initially outside our hospital, while two were our own unsuccessful urethroplasties. In the redo group, a perineal approach with inferior pubectomy was done in two boys and a transpubic urethroplasty in the remaining four boys. The success rate of anastomotic urethroplasty without any ancillary procedures was 81.5% (strict criterion), while the overall success rate was 94.7% (permissible criterion, which included boys who were managed later with direct vision internal urethrotomy and dilatation). Conclusion The ideal treatment of post-traumatic posterior urethral defect/strictures in boys is tension-free bulbo-prostatic anastomosis. This was done using a transperineal approach in most of the boys, but a few required a transpubic approach, with good results. Abbreviations DVIU: direct vision internal urethrotomy; SPC: suprapubic cystostomy; SUI: stress urinary incontinence

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Outcome of anastomotic urethroplasty in traumatic stricture (distraction defect) of posterior urethra in boys

Zafar¹,

Hayat²,

Amin³

et al. 2020

Arab Journal of Urology

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“…Urethral injuries in these patients are often accompanied by butterfly fracture of symphysis pubis with or without diastasis of one sacroiliac joint 11 . The most common etiologies of strictures or defects of the posterior urethra are motor vehicle accidents [12][13][14][15][16] . The interval between the initial urethral injury and definitive repair of the resulting urethral stricture or defect depends on the magnitude of the pelvic trauma.…”

Section: Introductionmentioning

confidence: 99%

Surgical Repair of Posterior Urethral Distraction Defects and its Outcome : Initial Experience in a Tertiary Level Hospital

et al. 2020

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Purpose: Management of posterior urethral distraction defects are challenging for urologists and need very careful and meticulous dissection for getting a good outcome. Dhaka medical college hospital is a tertiary referral hospital where we receive a lot of cases from different districts. The study was done to observe the outcome of anastomotic urethroplasty for posterior urethral distraction defects. Methods : This was a prospective experimental study. This study was done in a single unit of DMCH urology department by a single surgeon . Those who were suffering from posterior urethral distraction defects with suprapubic catheter in situ were included and underwent anastomotic urethroplasty from the period of January, 2018 to october, 2019. After proper evaluation and counseling all patients underwent perineal anastomotic urethroplasty under spinal anesthesia with 6-8 interrupted suture, using 4/0 vicryl. A 14 Fr Foley catheter was placed in urethral lumen and 16 Fr catheter in SPC site. A latex strip drain was placed for perineal wound. Drain was removed after 48 hours of operation . Patients were usually discharged in between 5th to 7th POD with definite follow up protocol and medications with supra pubic catheters (SPC) and per urethral catheters in situ. On 21 POD urethral catheter was removed. SPC was removed after 7 days if patient can void normally. 1st and 2nd follow up were done at the completion of 3rd and 6th month respectively. The prevalence of post-operative sexual disorders was investigated using the International Index of Erectile Function-5 (IIEF-5) questionnaire during follow-up. If the patient can able to void per urethra in a well manner and Qmax>15 mL/s then repair was defined successful. Result : Success rate of perineal anastomotic urethroplasty for posterior urethral distraction defect was 83.33.%. 18 patients were included in the study. The mean age was 28.27 years. 17 patients were able to void successfully after surgical procedure but among those 2 patients had urinary flow rate < 15 ml/sec and one patient didn’t able to void. 3 patients had developed wound infection, 3 patients developed erectile dysfunction. Conclusion : Perineal anastomotic urethroplasty is gold standard for treatment of posterior urethral distraction defects. Long term follow up is needed to give a opinion regarding the ultimate outcome of the surgical procedure and that have give a good idea for future management. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.193-198

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“…The risk of incontinence due to sphincter weakness following anastomotic urethroplasty is very low as continence depends on the intact bladder neck. 6 Open bladder neck seen cystoscopy and/or cystography before urethroplasty may herald postoperative incontinence. 7 At present; the preferred option is to manage the PFUDD and bladder neck problem sequentially.…”

Section: Introductionmentioning

confidence: 99%

Experience and Challenges in the Management of Pelvic Fracture Urethral Distraction Defect (Pfudd) by Excision and End to End Urethroplasty

Mathur¹,

Odiya²,

Patil³

2014

jemds

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To identify and study various factors and complications that crop up in postoperative period and pose a challenge to the treating urologist in providing a satisfactory outcome to patients. MATERIAL AND METHODS: 240 patients who underwent urethroplasty were included in this study. Patients were followed up postoperatively at 6 week and 6 month. The retrospective arm was used as experience and existing complications were taken as challenge for improvising urethroplasty skills in management of urethral stricture secondary to PFUDD. RESULTS: majority of the patients were of reproductive age group, with bulb membranous junction as the most common location. Of all about 60% had TILE A grade of pelvic fractures, 27% had TILE B and 13% with TILE C. at 6 week follow up post urethroplasty none of the patient had recurrence of the stricture, 15 (6.25%) had erectile dysfunction and 5 (2.08%) patients presented with the complications of the urinary incontinence. At 6 month follow up after urethroplasty 15(6.25%) patients developed recurrence of stricture 5 out of 15 who presented with erectile dysfunction showed improvement

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Traumatic Posterior Urethral Disruptions in Boys: Experience With the Perineal/Perineal–Transpubic Approach in Ten Cases

Cited by 3 publications

References 0 publications

Outcome of anastomotic urethroplasty in traumatic stricture (distraction defect) of posterior urethra in boys

Outcome of anastomotic urethroplasty in traumatic stricture (distraction defect) of posterior urethra in boys

Surgical Repair of Posterior Urethral Distraction Defects and its Outcome : Initial Experience in a Tertiary Level Hospital

Experience and Challenges in the Management of Pelvic Fracture Urethral Distraction Defect (Pfudd) by Excision and End to End Urethroplasty

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