Traumatic Rupture of the Supramembranous Urethra

Crassweller, P.O.; Farrow, G.A.; Robson, Charles J.; Russell, Jennifer; Colapinto, V.

doi:10.1016/s0022-5347(17)58188-4

Cited by 25 publications

(5 citation statements)

References 6 publications

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“…Problems with emission and/or ejaculation often present as infertility and occur in up to 90% of post-PFUI patients despite the majority of patients have antegrade ejaculation ( 161 , 270 , 303 - 305 ). This is usually due to damage to the lumbar sympathetic nerves and the hypogastric and pelvic plexus in those with loss of emission, or secondary to reduced perineal muscle function in those with ejaculatory problems ( 161 , 271 ).…”

Section: Post-pelvic Fracture Edmentioning

confidence: 99%

Pelvic fracture urethral injury in males—mechanisms of injury, management options and outcomes

Barratt

Bernard

Mundy

et al. 2018

Transl. Androl. Urol.

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Pelvic fracture urethral injury (PFUI) management in male adults and children is controversial. The jury is still out on the best way to manage these injuries in the short and long-term to minimise complications and optimise outcomes. There is also little in the urological literature about pelvic fractures themselves, their causes, grading systems, associated injuries and the mechanism of PFUI. A review of pelvic fracture and male PFUI literature since 1757 was performed to determine pelvic fracture classification, associated injuries and, PFUI classification and management. The outcomes of; suprapubic catheter (SPC) insertion alone, primary open surgical repair (POSR), delayed primary open surgical repair (DPOSR), primary open realignment (POR), primary endoscopic realignment (PER), delayed endoscopic treatment (DET) and delayed urethroplasty (DU) in male adults and children in all major series have been reviewed and collated for rates of restricture (RS), erectile dysfunction (ED) and urinary incontinence (UI). For SPC, POSR, DPOSR, POR, PER, DET and DU; (I) mean RS rate was 97.9%, 53.9%, 18%, 58.3%, 62.0%, 80.2%, 14.4%; (II) mean ED rate was 25.6%, 22.5%, 71%, 37.2%, 23.6%, 31.9%, 12.7%; (III) mean UI rate was 6.7%, 13.6%, 0%, 14.5%, 4.1%, 4.1%, 6.8%; (IV) mean FU in months was 46.3, 29.4, 12, 61, 31.4, 31.8, 54.9. For males with PFUI restricture and new onset ED is lowest following DU whilst UI is lowest following DPOSR. On balance DU offers the best overall outcomes and should be the treatment of choice for PFUI.

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Section: Post-pelvic Fracture Edmentioning

confidence: 99%

Pelvic fracture urethral injury in males—mechanisms of injury, management options and outcomes

Barratt

Bernard

Mundy

et al. 2018

Transl. Androl. Urol.

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“…Early closed realignment (railroading) was used as initial line of treatment for urethral disruption with data showed that this technique did not change the incidence of impotence. [ 20 21 22 23 ] These data also demonstrated that, with early closed alignment of the ruptured urethra, some patients did not develop stricture at all and that stricture, if formed in other patients, it would be short and easily managed by internal urethrotomy or dilatation without the need for open surgery.…”

Section: Discussionmentioning

confidence: 92%

“…On the contrary in other studies, urethral injury managed by early realignment (railroading) of the urethra showed that the cumulative incidences of stricture in 320 cases were 54% (range from 14% to 75%). [ 20 21 22 23 24 25 26 27 28 ]…”

Section: Discussionmentioning

confidence: 99%

Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experience

Darawany

2018

Urol Ann

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Introduction:The optimal management strategy for urethral injuries remains controversial. Suprapubic cystostomy followed by delayed urethral reconstruction or immediate primary urethral injury repair is associated with high complication rate. Early endoscopic realignment for urethral injuries provides early definitive procedure with low complications and avoids the need for further urethral reconstruction.Materials and Methods:Between April 2007 and March 2016, 27 patients with traumatic posterior urethral disruptions were reviewed. All patients were managed by endoscopic urethral realignment. Patients were followed up every 3 months for 18–36 months regarding incontinence, potency, and urine flow.Results:Endoscopic urethral realignment was performed immediately in 21 patients and was delayed in 6 patients. It was successful in 24/27 (88.8%) patients. During the procedure, the proximal urethral end was identified directly in four patients, and by the guidance of methylene blue injection, guidewire or endoscopic light in three, nine, and eight patients, respectively. The Foley catheter was removed after 9 weeks in 17/24 (70.8%) patients and after 12 weeks in 7/24 (29.2%) patients. Six months after realignment, minimal urethral stricture was developed in 4/24 (16.7%) patients. All of them were treated successfully with single session of internal urethrotomy without recurrence after 1-year follow-up. After 18–36-month follow-up period, all patients were potent, continent, and with satisfactory voiding pattern.Conclusions:Endoscopic primary realignment of posterior urethral rupture is less invasive and a safer procedure, without pelvic hemorrhage or additional injuries. It has low incidence of severe urethral stricture and avoids the need for delayed open urethral reconstruction.

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“…Table 2 presents the clinical series in which a primary realignment was performed with minimal traction showing more favourable results [14] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] .…”

Section: Treatment Of Posterior Urethral Injuriesmentioning

confidence: 99%

“… Clinical series No. of patients Follow-up, months (range) Erectile dysfunction, n (%) Incontinence n (%) Stricture rate a n (%) Gibson, 1974 [17] 35 b NA 12 (34) 1 (3) 26 (74) Crassweller et al., 1977 [18] 38 24–240 19/42 (45) NA 12 (32) Follis et al., 1992 [19] 20 42 (1–360) 4 (20) 2 (10) 12 (60) El-Abd, 1995 [20] 44 NA 35 (79) 0 44 (100) Elliott and Barret, 1997 [14] 53 126 (1–120) 11 (21) 2 (4) 36 (68) Porter et al., 1997 [21] 10 10.9 (2–31) 1/7 (14) 0 5 (50) Tahan et al., 1999 [22] 13 29 3 (23) 0 5 (39) Asci et al., 1999 [23] 20 39 (19–78) 4 (20) 2 (10) 9 (45) Moudouni et al., 2001 [24] 23 68 (18–155) 4/29 (14) 0 16 (70) Mouraviev et al., 2005 [16] 57 105 (12–264) 19 (34) 10 (18) 28 (49) Leddy et al., 2012 [25] …”

Section: Treatment Of Posterior Urethral Injuriesmentioning

confidence: 99%

Treatment of posterior urethral distractions defects following pelvic fracture

Ríos

Martínez‐Piñeiro

2018

Asian Journal of Urology

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Posterior urethral injuries typically arise in the context of a pelvic fracture. Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected. Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first. Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction. The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury. Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3–6 months continues to be the gold standard of treatment. In this paper, we provide a comprehensive review of the literature with a special emphasis on the various treatments available: Open or endoscopic primary realignment, immediate or delayed urethroplasty after suprapubic cystostomy, and delayed optical urethrotomy.

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Traumatic Rupture of the Supramembranous Urethra

Cited by 25 publications

References 6 publications

Pelvic fracture urethral injury in males—mechanisms of injury, management options and outcomes

Pelvic fracture urethral injury in males—mechanisms of injury, management options and outcomes

Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experience

Treatment of posterior urethral distractions defects following pelvic fracture

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