[Delayed end-to-end anastomotic repair of post-traumatic posterior urethral rupture]

Objective: To analyse the long-term results of the treatment of post-traumatic posterior urethral rupture by delayed bulboprostatic anastomotic repair and to evaluate the efficacy and advantages of this technique

Patients and Methods: Between February 1989 and February 2004, 15 patients underwent delayed bulboprostatic anastomotic repair of post-traumatic posterior urethral ruptures. The results were evaluated taking into account the quality of micturition, continence and erectile function

Results: After an average follow-up period of 34 months [range: 12 - 72 months], all our 15 patients were continent and voided with a satisfactory flow. To achieve this result, 5 patients [33.3%] had to undergo internal ureterotomy. Only 4 patients [26.7%] reported erectile problems

Conclusion: Delayed bulboprostatic anastomotic repair remains the "gold standard" in the treatment of post-traumatic posterior urethral rupture. Compared to other methods of treatment of post-traumatic stenosis of the ureter, this technique allows for a long-term success with minimal complications

Resultats globaux du traitment de l'infection postfracuraire: pseudarthroses et osteites postfracturaraies

The authors report their experiment in treating osteitis and septic non-union. - The problem of fractured osteitis is relatively simple, the fracture being united. Different surgical methods are considered together, all having in common the excision of infected and necrotic tissue. Opinions are divided between supporters of " closed " treatment with " irrigation-drainage ", and " open " treatment with cicatrization by a second intention. The latter being favored by most of the participants. Directed antibiotherapy remains a valuable addition; its utilization locally is discussed. - The treatment of septic " non-union " is more complicated in respect to healing. Different methods are examined with ' osteo-muscular decortication, used alone, led to healing in 17 out of 20 cases of non-union. It constitutes the first and formes treatment for non-union. Isolated, it is reserved for non-union without loss of osseous matter. A PAPINEAU intervention is the method of choice for septic non-union with loss of osseous matter. It was used once or twice in 51 cases and led to union and drving in 75% of the cases. Negative re-results were most often the apanage of diaphysaric resections. Inter-tibio-fibular grafting was only used in 8 cases, usually after the failure of other methods. It allowed union in 6 cases. It retains a non-negligible place after failure of a PAPINEAU intervention, which it can complete in case of insufficient solidity. Of 101 observations of septic non-union, 6 patients underwent amputation. This is most often the result of major traumatologic damage and deficient techniques. Its place should be more and more reduced. The authors conclude by recalling the importance of preventing post-operatory-infection, not by gross means but by rigorous measures in the organization, hygiene and education of hospital staff