Urethral reconstruction for pelvic fracture urethral distraction defects in boys: A 10-year experience

Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty.

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114: Flow Rate Pattern after Pelvic Fracture Urethral Reconstruction

The Journal of Urology ◽

10.1016/s0022-5347(18)30379-3 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 39-39 ◽

Cited By ~ 1

Author(s):

Daniela E. Andrich ◽

Jodi P. Hirst ◽

Anthony R. Mundy

Keyword(s):

Pelvic Fracture ◽

Flow Rate ◽

Urethral Reconstruction

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Delayed Anastomotic Urethroplasty in Children and Adolescence with Pelvic Fracture Urethral Injury (PFUI): Experiences in Two Centers of Reconstructive Urethral Surgery in Indonesia

Indonesian Medical and Life Science Journal ◽

10.53536/melisa.v1i2.17 ◽

2021 ◽

Vol 1 (2) ◽

pp. 58-65

Author(s):

Paksi Satyagraha ◽

Kuncoro Adi ◽

I Made Udiyana Indradiputra ◽

Ahmad Agil ◽

Besut Daryanto

Keyword(s):

Success Rate ◽

Pelvic Fracture ◽

Average Length ◽

Operation Time ◽

Urethral Injury ◽

Urethral Reconstruction ◽

Tension Free ◽

Children And Adolescence ◽

Urethral Surgery ◽

Anastomotic Urethroplasty

Introduction: Incidence of pediatric pelvic fracture urethral injury (PFUI) is rare. This study reviews the experience of anastomotic urethroplasty surgery in children and adolescence PFUI in the last 3 years in two center of reconstructive urethral surgery in Indonesia. Method: This study retrospectively reviewed PFUI cases in Hasan Sadikin Hospital and Saiful Anwar Hospital from 2013-2016. The data cases were analysed base on aetiology of the trauma, urethral gap, and previous operations. The operation time and intra operative additional procedure to achieve tension free anastomotic was also noted. Result: A total 31 children and adolescence patients with PFUI were recorded in two institutions. Twenty patients were in Hasan Sadikin Hospital while 11 patients were in Saiful Anwar Hospital. The trauma mechanisms for PFUI were 28 (90.3%) cases due to motorcycle accidents and 3 (9.7%) cases due to high falls accidents. All patients underwent delayed urethral reconstruction in median 6 months (3-72). The median operation time was 150±101 minutes for children and 160±50.5 minutes for adolescence. The average length of the urethral gap in children cases was 2.8±1.2 cm, meanwhile 4±1.9 cm for adolescence cases. In order to achieve the tension free of anastomotic urethroplasty, 5 (16.1%) of PFUI patients underwent crural separation, 16 (51.6%) patients underwent inferior pubectomy and 3 (9.7%) patients for supracrural re-routing. Posterior pubectomy with omental wrap via transpubic approach was performed in one patient. The success rate for children cases was 83.3% and 88% for adolescence cases. Thus, the overall success rate after anastomotic urethroplasty for pediatric PFUI was 83.9%. Conclusions: In short-term follow up, delayed repair urethral reconstructive surgery by transperineal and transpubic anastomotic urethroplasty in children and adolescence with PFUI achieved a significant good result and showed promising outcome.

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Genitourinary injuries associated with pelvic fractures

Acta chirurgica iugoslavica ◽

10.2298/aci1302117p ◽

2013 ◽

Vol 60 (2) ◽

pp. 117-120 ◽

Cited By ~ 6

Author(s):

Tomislav Pejcic ◽

Zlatibor Loncar ◽

Dragutin Rafailovic ◽

Miodrag Acimovic ◽

Zoran Dzamic ◽

...

Keyword(s):

Pelvic Fracture ◽

Motor Vehicle ◽

Pelvic Fractures ◽

Motor Vehicles ◽

Urethral Reconstruction ◽

Tertiary Institutions ◽

Vehicle Accidents ◽

Clinical Center ◽

Bladder Injuries ◽

Urethral Injuries

Introduction: Pelvic fractures represent approximately 3% of all skeletal injuries. About 15% of patients with pelvic fractures have associated bladder or urethral injuries. The most common causes of pelvic fracture are motor vehicle accidents, motorcycle crashes, motor vehicles striking pedestrians, and falls. Material and methods: Retrospective study included the patients treated in the Emergency Center, Clinical Center of Serbia, Belgrade, between 2000 and 2009. Of 7445 patients, there were 894 injuries of the urinary tract and 376 pelvic fractures; 55 patients with pelvic fractures (14.6%) had bladder or urethral injuries. There were 31 patients with bladder injuries, 22 patients with urethral injuries, and two patients with associated injuries of the posterior urethra and the bladder neck. Results: The bladder injuries were treated by surgical exploration, cystostomy, suture of the bladder lesions and urethral catheterization. Urethral injuries were treated by primary cystostomy and urethral reconstruction and catheterization in 18 patients (82%), while cystofix-cystostomy was performed in four patients (18%). Discussion: Genitourinary injuries increase overall mortality in patients with pelvic fracture, compared with traumas without associated GU injuries. These patients require multidisciplinary approach, preferably in tertiary institutions.

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Partial Inferior Pubectomy in the Delayed Repair of Pelvic Fracture Urethral Injury: Adopting a Bone-nibbling Technique

Annals of African Surgery ◽

10.4314/aas.v18i2.2 ◽

2021 ◽

Vol 18 (2) ◽

pp. 69-74

Author(s):

Ikenna Ifeanyi Nnabugwu ◽

Fredrick Obiefuna Ugwumba ◽

Anthony Alex Ilukwe

Keyword(s):

Pelvic Fracture ◽

Urethral Injury ◽

Pubic Bone ◽

Resource Poor Setting ◽

Previous Attempt ◽

Urethral Reconstruction ◽

Inferior Margin ◽

Delayed Repair ◽

Post Operation ◽

Urethral Defect

Background: The use of wedge inferior pubectomy can be challenging to many urethral surgeons. Our objective was to introduce a bone-nibbling technique to accomplish a partial inferior pubectomy (PIP) in a resource-poor setting, and to report the medium- to longterm outcome of using the technique. Methods: Five patients were recruited (mean age: 38.8 years) who presented, over a 30-month period, with posterior urethral fibrosis from a pelvic fracture urethral injury (PFUI). One had failed a previous attempt at posterior urethral reconstruction elsewhere. The length of urethral defect was from 2 to 4 cm. We describe a bone-nibbling technique used to carry out PIP for the delayed repair of PFUI in these patients. The outcomes in the medium to long term of surgical procedures done with this technique are presented. Results: Immediate postoperative complications in all were essentially a Clavien–Dindo grade I. Peak flow rate assessed 12 weeks’ post operation was between 20 mL/s and 23 mL/s (mean: 21 mL/s). The longest duration of follow-up was 34 months, and all patients were voiding satisfactorily. Conclusions: A satisfactory and durable outcome can be obtained from nibbling at the bone from the inferior margin of the pubic bone to achieve PIP. This is of interest to lower urinary tract reconstructive surgeons who have concerns with chiseling-out wedge of the inferior pubis. Keywords: Bone nibbling, Partial inferior pubectomy, PFUI, Posterior urethra, Urethral anastomosis

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