Usefulness of a high‐speed surgical air drill in pubectomy during delayed anastomotic urethroplasty for pelvic fracture urethral injury

Horiguchi, Akio; Ojima, Kenichiro; Shinchi, Masayuki; Hirano, Yusuke; Hamamoto, Koichi; Ito, Keiichi; Asano, Tomohiko; Azuma, Ryuichi

doi:10.1111/iju.14344

Cited by 6 publications

(3 citation statements)

References 24 publications

(60 reference statements)

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“…Second, there is a greater chance of injuring the dorsal vein complex (DVC) during redo-pubectomy because the pubic bone is resected closer to the DVC. Preoperative magnetic resonance imaging may be used to assess the anatomical relationship of the DVC to the pubic bone and whether it has atrophied [ 16 ] to evaluate the risk of intraoperative bleeding fully. During surgery, the corporeal body was dissected further distally along the septum to expose the pubic surface.…”

Section: Discussionmentioning

confidence: 99%

Redo inferior pubectomy for failed anastomotic urethroplasty in pelvic fracture urethral injury

Wang,

Song,

Peng

et al. 2023

Curr Urol

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Objectives To assess the effect of redo inferior pubectomy on the management of complicated pelvic fracture urethral injury (PFUI) in patients with a history of failed anastomotic urethroplasty. Materials and methods We retrospectively reviewed all patients receiving redo anastomotic urethroplasty with redo inferior pubectomy for failed PFUI between January 2010 and December 2021. Patients with incomplete data and those who were lost to follow-up were excluded. Successful urethroplasty was defined as the restoration of a uniform urethral caliber without stenosis or leakage and further intervention. Functional results, including erectile function and urinary continence, were evaluated. Descriptive statistical analyses were then performed. Results Thirty-one patients were included in this study. Among them, concomitant urethrorectal fistula occurred in 2 patients, and concomitant enlarged bladder neck occurred in 1. The stenosis site was the bulbomembranous urethra in 2 patients and the prostatomembranous urethra in 29. The mean length of urethral stenosis in all patients was 3.1 cm (range, 2.0–5.0 cm). After a mean follow-up of 34.6 months, the final success rate was 96.8%. The incidence of erectile dysfunction reached 77.4% (24/31). Normal continence was achieved in 27 (87.1%) patients. One patient developed urinary incontinence of grade II requiring urinal pads because of an enlarged bladder neck. According to the Clavien-Dindo classification, postoperative complications of grade I occurred in 7 patients and grade II in 4. Conclusions Repeat anastomotic urethroplasty with repeat inferior pubectomy provides reliable success rates for failed PFUI. In complicated cases, it must be known and mastered.

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Section: Discussionmentioning

confidence: 99%

Redo inferior pubectomy for failed anastomotic urethroplasty in pelvic fracture urethral injury

Wang,

Song,

Peng

et al. 2023

Curr Urol

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“…Inferior partial pubectomy was performed by surgical air drilling to widen the exposure (Figure 2a). 10 The location of the bladder neck was identified using a flexible cystoscope inserted through the suprapubic tract (Figure 2b). Scarred membranous urethra and fibrotic prostatic tissue were meticulously excised, and the bladder neck was opened.…”

Section: Methodsmentioning

confidence: 99%

Transperineal bulbovesical anastomosis for extensive posterior urethral stenoses after treatment of prostatic disease

et al. 2022

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Objectives We report our surgical experience of transperineal bulbovesical anastomosis (BVA) for extensive posterior urethral stenosis (PUS). Methods Six male patients who had extensive PUS extending from the bulbomembranous urethra to the bladder neck due to prostatic disease treatment and underwent transperineal BVA between 2014 and 2020 were retrospectively reviewed. BVA was performed according to the elaborate perineal approach for pelvic fracture urethral repair with minor modifications. After confirming the absence of recurrent stenosis 6 months postoperatively, the patients were offered artificial urinary sphincter (AUS) placement for subsequent urinary incontinence (UI). Results Median patient age was 68, and the etiology of PUS was radical prostatectomy for prostate cancer in four patients, brachytherapy for prostate cancer in one, and transurethral resection of the prostate for benign prostatic hyperplasia in one. All patients had been previously treated with multiple transurethral procedures such as urethrotomy and dilation. Median operative time and blood loss were 211 min and 154 ml, respectively. Five cases (83.3%) had no recurrent stenosis with a median follow‐up of 45 months, but a single direct vision internal urethrotomy was performed in one (16.7%) due to restenosis. Four (66.7%) patients underwent AUS placement via transcorporal approach for subsequent UI, but two had it removed due to urethral erosion. Conclusion Transperineal BVA could effectively manage extensive PUS after prostatic disease treatment. Staged AUS placement could be a viable option for subsequent UI, but the risk of urethral erosion seemed high.

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“…2d). 23 MRI clearly shows the positional relationship between the pubic bone and the dorsal venous complex, and might alert the surgeon. Furthermore, MRI can show minor periurethral fistulae that might be missed on conventional urethrography (Fig.…”

Section: Essential Mri Information In Pfui Patientsmentioning

confidence: 99%

Role of magnetic resonance imaging in the management of male pelvic fracture urethral injury

et al. 2022

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The management of male pelvic fracture urethral injury remains a urological challenge. Pelvic fracture urethral injury can be associated with sequelae, such as urethral gap, erectile dysfunction and urinary incontinence. Delayed anastomotic urethroplasty, the gold standard treatment for urethral gaps caused by pelvic fracture urethral injuries, is technically demanding, and reconstructive urologists should preoperatively obtain as much detailed anatomical information as possible. A combination of antegrade and retrograde urethrography is the fundamental preoperative evaluation, but it cannot accurately assess the urethral gap length, the degree of lateral prostatic displacement, the anatomical relationship of the urethra with its surrounding structures (such as the rectum and dorsal venous complex) or periurethral problems (such as minor fistulae or cavitation). To make up for these limitations of urethrography, magnetic resonance imaging has emerged as a non-invasive, multiplanar and high-resolution modality for the evaluation of pelvic fracture urethral injury. Magnetic resonance imaging has excellent soft-tissue contrast, and can clearly show the urethra and periurethral tissues without the effects of radiation, thus enabling clinicians to anticipate the required ancillary techniques for delayed anastomotic urethroplasty and to predict functional outcomes, such as erectile function and urinary continence, after delayed anastomotic urethroplasty. This review discusses the role of magnetic resonance imaging in the evaluation of pelvic fracture urethral injury and its impact on patient management.

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Usefulness of a high‐speed surgical air drill in pubectomy during delayed anastomotic urethroplasty for pelvic fracture urethral injury

Cited by 6 publications

References 24 publications

Redo inferior pubectomy for failed anastomotic urethroplasty in pelvic fracture urethral injury

Redo inferior pubectomy for failed anastomotic urethroplasty in pelvic fracture urethral injury

Transperineal bulbovesical anastomosis for extensive posterior urethral stenoses after treatment of prostatic disease

Role of magnetic resonance imaging in the management of male pelvic fracture urethral injury

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