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Aims & Objectives:About 10% of pelvic fracture injuries are associated with urethral injury. Most of the urethral injuries are successfully repaired by progressive perineal anastomotic urethroplasty. Bulbar urethral ischemic necrosis is a devastating complication seen in 5-8% of failed PFUI repairs. The objective of this study is to present our experience in management of a bulbar urethral ischemic necrosis developed following PFUI repair. Materials & methods:This is a retrospective study done at our institute, which includes data from feb,2003 to feb,2021. This is a descriptive statical analysis. Total 18 patients were managed using various surgical approaches and followed. Out of 18 patients seven patients underwent staged urethroplasty with Results & Observations: success rate of 85.71%,four underwent pedicled preputial skin tube urethroplasty with success rate of 75%,one underwent non transecting augmented urethroplasty with success rate of 100%,three underwent augmented perineal urethrostomy, two underwent continent diversion procedures, one underwent augmented perineal skin tube perineal urethrostomy. Bulbar urethral ischemic necrosi Conclusions: s following PFUI repair although uncommon, is a devastating complication which can be salvaged by various surgical techniques. Type of procedure chosen depends on individual patient and outcomes vary for each type of procedure
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A locked pubic ramus body is an unusual variant of lateral compression injury. Till date, there have been only 25 cases reported in the published literature. We herein described a case where the right pubic ramus was entrapped within the opposite obturator foramen with an overlap of greater than 4 cm, with associated urethral injury. When all maneuvers of closed and instrumented reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate. The patient underwent delayed urethral repair 10 weeks after the index surgery. At 3-year follow-up, the patient has sexual dysfunction especially difficulty in maintaining erection, secondary urethral stricture, heterotopic ossification, and breakage of implants.
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Humans , Pubic Bone/injuries , Follow-Up Studies , Osteotomy, Sagittal Split Ramus , Pelvis , Urethra/surgery , Pubic Symphysis/injuriesABSTRACT
Penile fracture (PF) is a surgical emergency. Given its rarity, we queried a national cohort over an 11-year period to study the temporal and demographic variations in presentation, evaluation, and management of patients with PF compared with a cohort of control patients. The National Inpatient Sample was queried between the years 2005 and 2016 for patients with a diagnosis of PF. Appendectomy patients were selected as a control cohort, given the non-discriminatory nature of this disease. Clinical and demographic data of the patients were compared with that of controls. Presenting symptoms, rates of surgical repair, and rates of associated surgical procedures were evaluated in the PF cohort. During the study period, 5802 patients were hospitalized for PF. The annual incidence of PF remained unchanged at 1.0-1.8 cases per 100 000 hospitalizations over the study period. Compared with the control cohort, PF patients were more likely to be younger (38.7 years vs 41.2 years, P ≤ 0.001), have lower rates of comorbidities except erectile dysfunction (1.4% vs 0.1%, P ≤ 0.001), and were more likely of Black race (25.4% vs 6.2%, P ≤ 0.001). Notably, PF patients had significantly higher rates of substance abuse (26.4% vs 18.1%, P ≤ 0.001), despite no difference in the diagnosed psychiatric disorders. PF rarely presented with hematuria (3.5%); however, urethral evaluation was performed in 23.1%, most commonly with cystoscopy (19.2%). PF occurs more commonly in a younger, healthier male population, and among minorities. Importantly, rates of substance abuse appear to be higher in the PF cohort compared with those of controls.
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This study aimed to evaluate whether adding a vacuum erection device (VED) to regular use of Tadalafil could achieve better penile rehabilitation following posterior urethroplasty for pelvic fracture-related urethral injury (PFUI). Altogether, 78 PFUI patients with erectile dysfunction (ED) after primary posterior urethroplasty were enrolled and divided into two treatment groups: VED combined with Tadalafil (Group 1, n = 36) and Tadalafil only (Group 2, n = 42). Changes in penile length, testosterone level, International Index of Erectile Function-5 (IIEF-5) questionnaire, Quality of Erection Questionnaire (QEQ), and nocturnal penile tumescence (NPT) testing were used to assess erectile function before and after 6 months of ED treatment. Results showed that the addition of VED to regular use of Tadalafil preserved more penile length statistically (0.4 ± 0.9 vs -0.8 ± 0.7 cm, P < 0.01). IIEF-5 score and QEQ score in Group 1 were higher than Group 2 (both P < 0.05). After treatment, 21/36 (58.3%) Group 1 patients and 19/42 (45.2%) Group 2 patients could complete vaginal penetration. Group 1 patients also had markedly improved testosterone levels (P = 0.01). Unexpectedly, there was no significant difference in NPT testing between two therapies. For PFUI patients with ED after posterior urethroplasty, the addition of VED to regular use of Tadalafil could significantly improve their conditions - improving erection and increasing penile length - thus increasing patient satisfaction and confidence in penile rehabilitation.
Subject(s)
Adult , Humans , Male , Middle Aged , Young Adult , Combined Modality Therapy/methods , Erectile Dysfunction/rehabilitation , Penile Erection , Penis/surgery , Phosphodiesterase 5 Inhibitors/therapeutic use , Tadalafil/therapeutic use , Treatment Outcome , Urethra/surgery , VacuumABSTRACT
This study aimed to evaluate whether adding a vacuum erection device (VED) to regular use of Tadalafil could achieve better penile rehabilitation following posterior urethroplasty for pelvic fracture-related urethral injury (PFUI). Altogether, 78 PFUI patients with erectile dysfunction (ED) after primary posterior urethroplasty were enrolled and divided into two treatment groups: VED combined with Tadalafil (Group 1, n = 36) and Tadalafil only (Group 2, n = 42). Changes in penile length, testosterone level, International Index of Erectile Function-5 (IIEF-5) questionnaire, Quality of Erection Questionnaire (QEQ), and nocturnal penile tumescence (NPT) testing were used to assess erectile function before and after 6 months of ED treatment. Results showed that the addition of VED to regular use of Tadalafil preserved more penile length statistically (0.4 ± 0.9 vs -0.8 ± 0.7 cm, P < 0.01). IIEF-5 score and QEQ score in Group 1 were higher than Group 2 (both P < 0.05). After treatment, 21/36 (58.3%) Group 1 patients and 19/42 (45.2%) Group 2 patients could complete vaginal penetration. Group 1 patients also had markedly improved testosterone levels (P = 0.01). Unexpectedly, there was no significant difference in NPT testing between two therapies. For PFUI patients with ED after posterior urethroplasty, the addition of VED to regular use of Tadalafil could significantly improve their conditions - improving erection and increasing penile length - thus increasing patient satisfaction and confidence in penile rehabilitation.
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Background and Objectives: Catheterization related urethral injury (CRUI), particularly in men, is common and produces significant morbidity. However, it seems to have gathered little interest of concerned authorities towards prevention. The objective of the study is to reveal that many CRUI are usually due to improper technique.Material and Methods: This is a retrospective and descriptive study carried out at Janaki Medical College & Teaching Hospital, Janakpur between May 2013 and September 2016. It included 18 male patients presenting in emergency with acute CRUI. Re-catheterization was attempted by experienced surgeons in them unless there was history suggestive of urethral stricture and the outcome was analyzed.Results: Mean age of the patients was 62.9 ± 17.7 (range: 22 - 90) years. When the consultant attended them, 8 (44.4%) patients had catheter in place with intraurethral balloon inflation (IUBI), and 10 patients had catheter removed. One patient in each group had scrotal hematoma suggesting urethral perforation. Excluding two patients with typical history suggestive of urethral stricture, manual urethral re-catheterization was attempted by surgeon in 16 patients and succeeded in 12 (75%) patients, which was remarkable. Rest of the 6 patients had suprapubic catheterization.Conclusion: Most of the CRUI results from technical fault and are potentially preventable.
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Objective To investigate the risk factors of pelvic fracture related urethral injury (PFUI).Methods We retrospectively reviewed 120 patients with pelvic fracture from March 2014 to October 2016 in our hospital.Of all the patients,87 were males and 33 were females.The average age was (42.6 ± 15.4) years old (ranging 1 1-78 years old).The etiology of pelvic fracture included traffic accident in 70 cases,fall injury in 27 case.Heavy crash in 23 cases.43 male patients had an PFUI.Their average age was (40.4 ± 14.5) years old (ranging 14-61 years old).Of PFUI patients,the location of urethral injury included membranous part in 16 cases,bulbomenbranous part in 17 and prostatic part in 10 cases.The average length of stricture was (3.0 ± 1.9) centimeter.One patient suffered the stricture,combined with bladder rupture.One patient had urethro-rectal fistula.Two patients had urethrocutaneous fistula.The pelvic fractures were categorized using Tile classification,including type A1 fractures in 10 cases,A2 in 10 cases,B1 in 14 cases,B2 in 31 cases,B3 in 42 cases,C1 in 2 cases and C2 in 11 cases.The patients' number of urethral injury in each type was 1,2,2,7,29,0,2,respectively.Hazard degree analysis and chisquare test were used to evaluate the risk factors.Variables with an association of P ＜ 0.05 were then tested using binary logistic regression and the area under the curve(AUC).Results On hazard degree analysis,female(x2 =25.419,P ＜ 0.05,OR =0.571) and type B3 fracture (x2 =31.002,P ＜ 0.05,OR =10.198)have a significant impact on the occurrence of PFUI.On binary logistic regression,female(Walds =16.528,P ＜ 0.05,adjusted OR =0.003)is the protective factor of PFUI while type B3 fracture (Walds =10.853,P ＜0.05,adjusted OR =28.537) is the risk factor.The area under the curve (AUC =0.891,95％ CI0.826-0.956) illustrates the regression model has a high credibility.Conclusions Pelvic fracture urethral injury is much less likely to occur in females than men.Type B3 fracture is more likely to cause an PFUI than the others type.
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Objective To study the value of flexible cystoscopy in diagnosing posterior urethral strictures resulting from pelvic fracture and the pain score of the examination. Methods Between 2014 and 2015, 120 male patients with pelvic fracture urethral distraction defect were evaluated by cystoscopy before surgery. In this study, flexible cystoscopy was used in 87 patients, 33 patients received conventional rigid cystoscopy. The cystoscopy was introduced into the posterior urethra and the area was evaluated for the length of the proximal urethra and any possible fistulas, false passages, calculi or displacement of the posterior urethra. The patient’s pain feeling was recorded during the examination, 24 hrs after cystoscopy examination. The pain feeling result was achieved by visual analogue pain scale. Results Severe allergic reaction or obvious discomfort did not occur in any patients after cystoscopy. By comparing the data obtained from lfexible cystoscopy to those from conventional urethrography, the rate of detection in other abnormalities was higher in lfexible cystoscopy than in conventional urethrography. 21, 5, 7 and 5 patients were detected with calculus, posterior urethral structure damage, false passage and ifstula respectively. In comparison, the abnormalities were only observed in 3, 2, 3 and 1 patients respectively through conventional urethrography imaging. However, the pain feeling of the flexible cystoscopy is better than the convenional rigid cystoscopy. The statistical difference was found in the pain feeling score during the examination and later after the examination. Conclusions Flexible cystoscopy is a safe and valuable procedure in the evaluation of the posterior urethra in patients with pelvic fracture urethral distraction defect before surgery.
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AIM:To investigate the role of Rho-associated kinase ( ROCK) inhibitor fasudil in the formation of rabbit urethral stricture after injury and to observe the cell activity , migration and extracellular matrix synthesis in the rabbit urethra fibroblasts.METHODS:The rabbit model of urethral stricture was established by microsurgical techniques .The rabbits were divided into sham operation group , operation group and fasudil (3 mg/kg, 10 mg/kg, 30 mg/kg) groups.The diameter of the stenosis was measured by retrograde urethrography 3 months after surgery .The fibroblasts were isolated from urethral scar, and then incubated with fasudil (12.5 μmol/L, 25 μmol/L, 50 μmol/L) in the presence of transforming growth factor-β1 (TGF-β1, 10 μg/L).The untreated cells were used for control .The cell activity was measured by MTT assay.The cell migration ability was tested by the method of Transwell chambers .The protein expression of ROCK , α-smooth muscle actin (α-SMA) , collagen I and collagen III was determined by Western blot analysis .RESULTS:Fasudil significantly reduced formation of urethral stricture after injury (P<0.05).Cultured rabbit fibroblasts with different con-centrations of fasudil inhibited the cell activity and cell migration ability (P<0.05).The protein expression of ROCK,α-SMA, collagen I and collagen III was also inhibited by treatment with fasudil in a dose -dependent manner ( P<0.05 ) . CONCLUSION:Fasudil inhibits the formation of extracellular matrix and reduces the incidence of urethral stricture after injury by down-regulating TGF-β1-induced Rho/ROCK pathway activation in the rabbit urethra fibroblasts .
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Objective To discuss the diagnosis and treatment of iatrogenic urethral injuries and preventive measures.Methods Various clinical parameters in 26 cases of iatrogenic urethral injury between January 2006 to January 2014 were analyzed retro-spectively.Results Twenty-five cases were confirmed in the operation,1 case of confirmed 2 days postoperatively.All patients were follow-up visit for 3-24 months normal renal function,only 1 case of urethral stricture.Conclusion Through effective prevention, early diagnosis and treatment,close follow-up visit can minimize the patient′s occurrence of iatrogenic urethral injury.
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Objective To summarize the clinical experience of urethral realignment for treating early urethral injury under the guidance of ureteroscope,and evaluate its curative effect.Methods Twenty-nine male patients with urethral injury were selected,and 12 patients of posterior urethral injury,17 patients of former urethral injury.All the patients were treated with urethral realignment under the guidance of ureteroscope,postoperative indwelling catheter 3-8 weeks,every 7-16 days changed diameter increase 2 F the catheter 1 time.Results The 29 patients with urethral injury were a indwelling catheter success,all patients were no incontinence after operation 3 months.In the 29 patients,27 patients were urination unobstructed after catheter removal,2 patients were appeared urine line slim after 2 weeks,the 2 patients were normal urination after short urethral expansion.Conclusions The urethral realignment for treating early urethral injury under the guidance of ureteroscope has simple,lower complication,rapid recovery,better effect.The continuous flexible progressive urethral expansion and the strict nursing,which can effectively reduce the occurrence of urethral stricture.
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Objective To discuss the influent factors and managements of lower urinary tract injury caused by tension-free vaginal tape (TVT) procedure. Methods From Mar.2001 to Feb.2011,609stress urinary incontinence (SUI) patients were trested by TVT.Lower urinary tract injury appeared in 39 cases (6.4％),which age from 39 to 78 years (average age 52.7 ± 18.3).The history of disease was 2 to 12 years.Preoperative SUI types were 12 cases of Ⅱ type SUI,22 cases of Ⅱ/Ⅲ type SUI and 5 cases of Ⅲ type SUI.The patients who had low urinary tract injury were retrospective analyzed to figure out the causes and influent factors,and recorded the treatments and follow-ups. Results 39 patients (6.4％) suffered from low urinary tract injury,including 36 oases (5.9％) of bladder perforation and 3 cases of urethral injury.In these 39 patients,34 (87.2％) patients had history of pelvic surgeries,including 18 (52.9％) cases of total hysterectomy,9 (26.5％) cases of cesarean section delivery,4 (11.8％) cases of hysteromyomectomia and 3 (8.8％) cases of ovarian surgery.All of the 36 bladder peeroration patients were re-punctured and the catheter was kept for 4 - 5 d.Three urethral injury patients were re-punctured after the urethral rupture was sutured and the catheter was kept for 2 weeks.All the 39 patients were cured and discharged.No urinary fistula,infection or other postoperative complications occurred. Conclusions The history of pelvic surgery may be an important risk factor of the lower urinary tract injury,which should pay attention.If the bladder perforation occurred,re-puncture should be taken by adjust the direction.If there was a urethral injury,the re-puncture should be taken after the suturing of the urethral rupture.
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0.05 ). Conclusions The non-mended injury does not affect the therapeutic effect of the Madigan prostatectomy with the urethral injuries due to the operation.
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Urethral injury secondary to blunt trauma in the boys is fairly common occurrence, its diagnosis and management are well documented. Due to the low incidence of urethral injury in girls, there is no settled method of diagnosis and management. In this report, the clinical course of 2 young female patients with complete traumatic rupture of the uretha was evaluated in an effort to propose guide lines for the investigation and initial management of this unusual injury.
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Female , Humans , Diagnosis , Incidence , Pelvic Bones , RuptureABSTRACT
PURPOSE: There are a variety of open surgical and endoscopic methods to the treatment of urethral injuries. The objective of our study is to evaluate the efficacy of primary endoscopic urethral realignment according to the injury site. MATERIALS AND METHODS: Twenty eight patients with urethral injuries(23 anterior and 5 posterior) were treated by primary endoscopic urethral realignment from March 1990 to August 1997. According to the injury site, age distribution, etiology of injury, associated injuries, time to operation, operating time, duration of urethral Foley catheterization, maximal flow rate, postoperative complications and treatment of post-realignment stricture were reviewed. RESULTS: The age range of our patients was from 20 to 86 years(mean 45.0). Among the 28 patients, 23 were anterior and 5 were posterior urethral injuries. Pelvic bone fracture was associated in 1 patient(20.0%) in the anterior urethral injury group, while 5 patients(100%) in the posterior urethral injury group. The mean time after injury to realignment was 1.9 days (range 0 to 9) and the mean operating time was 53.9 minutes in the anterior urethral injury group(range 20-190) and 79.0 minutes in the posterior urethral injury group(range 25-170). The mean duration of urethral Foley catheterization was 24.5 days in the anterior urethral injury group and 61.4 days in the posterior urethral injury group. The mean maximal flow rate after catheter removal was 31.4ml/sec in the anterior urethral injury group and 24.6ml/sec in the posterior urethral injury group. Of the 23 patients, 9 patients(39.1%) had post-realignment strictures in the anterior urethral injury group and 8 were treated with visual urethrotomy, and only one patient was required open urethroplasty. Of the 5 patients, 4 patients(80.0%) had post-realignment strictures in the posterior urethral injury group and treated with visual urethrotomy. CONCLUSIONS: Primary endoscopic urethral realignment is a safe and simple technique with minimal mobidity regardless of injury site. The stricture formation, impotence and incontinence rates of this technique are comparable to those reported for open surgical methods. Finally, most post-realignment strictures can be treated successfully with visual internal urethrotomy with or without occasional sound dilation.
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Humans , Male , Age Distribution , Catheters , Constriction, Pathologic , Erectile Dysfunction , Pelvic Bones , Postoperative Complications , Urinary CatheterizationABSTRACT
Whether indwelling urethral catheter should be removed after urethroplasty or visual internal urethrotomy in patients with posterior urethral injured is still controversial. From May 1990 to February 1995, 28 patients with posterior urethral injury underwent retrograde pericatheter urethrography for the purpose of the evaluation of urethral continuity in the timing of the removal of indwelling urethral catheter. The indwelling catheter was removed in 24 patients whose urethra did not have any extravasation, and 4 patients had detectable extravasation. We conclude that retrograde pericatheter urethrogram is the most useful radiologically diagnostic method to evaluate in the timing of the removal of indwelling urethral catheter and to obtain the objective parameter of urethral patency in posterior urethral injured patients, postoperatively.
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Humans , Catheters , Catheters, Indwelling , Urethra , Urinary CathetersABSTRACT
In complicated posterior urethral injury following pelvic bone fracture, the commonest cause of incompetence of the bladder neck is the circumferential tethering by hematoma-fibrosis. In such cases, functional competence of bladder neck can be restored by mobilizing the bladder neck, by removing retropubic fibrosis, and by occluding the dead space with omental pedicle graft. Also the reliability of the urethral anastomosis can be greatly increased by the obliteration of any perianastomotic dead space with a pedicled omental graft This kind of operation is called Turner-Warwick perineo-abdominal progression approach and we experienced 3 cases in children.
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Child , Humans , Fibrosis , Mental Competency , Neck , Pelvic Bones , Transplants , Urinary BladderABSTRACT
Between March 1990 and April 1991. 6 patients presented with complete urethral rupture were treated by primary endoscopic urethral realignment The results were obtained as follows : 1. The ruptured sites were bulbous urethra in 3 cases. 2. The urethral Foley catheter was left indwelling for 25 to 132 days. (average : 66.3 days) 3. After removal of urethral Foley catheter, maximal flow rate was 32.6mI,sec. 4. The complications were impotence in l case and urethral stricture in 4 cases. The first attack of postoperative urethral stricture developed at average 9.9 days. The average length of urethral stricture was 4.5mm and average maximal flow rate was 11.2mI,sec. Urethral stricture was well managed by visual urethrotomy. After visual urethrotomy, maximal flow rate was 25.lml,sec. Therefore, we conclude that primary endoscopic urethral realignment was considered to be safe, simple and effective operative procedure for the treatment of complete urethral rupture.
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Humans , Male , Catheters , Erectile Dysfunction , Rupture , Surgical Procedures, Operative , Urethra , Urethral StrictureABSTRACT
This study was performed to compare the results according to initial managements in 130 patients with urethral injury during the period from January, 1978 to May, 1990. The following results were obtained : 1. Among the 130 patients ranged from 6 to 70 years of age with average of 35.4 years, 71 ruptures were complete and 59 were incomplete and pelvic bone fracture was associated in 40 patients(30.8%). 2. Of these patients. 44 who had mild urethral injury were managed by observation or indwelling of Foley catheter, 27 by primary realignment and 69 by suprapubic cystostomy only as a initial management. and thereafter urethral strictures were developed in 5(13.2%). 21(77.8%) and 48 (81.4%), respectively, with no statistical difference between later two groups. 3. In the cases of urethral stricture who were treated by suprapubic cystostomy as a initial management required more complicated surgical procedures such as end to end anastomosis or staged urethroplasty for the correction than primary realignment. 4. Complications other than stricture such as impotence, urinary tract infection, stone, or fistula were developed in both groups similarly.
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Humans , Male , Catheters , Constriction, Pathologic , Cystostomy , Erectile Dysfunction , Fistula , Pelvic Bones , Rupture , Urethral Stricture , Urinary Tract InfectionsABSTRACT
This study was performed to compare the results according to initial managements in 130 patients with urethral injury during the period from January, 1978 to May, 1990. The following results were obtained : 1. Among the 130 patients ranged from 6 to 70 years of age with average of 35.4 years, 71 ruptures were complete and 59 were incomplete and pelvic bone fracture was associated in 40 patients(30.8%). 2. Of these patients. 44 who had mild urethral injury were managed by observation or indwelling of Foley catheter, 27 by primary realignment and 69 by suprapubic cystostomy only as a initial management. and thereafter urethral strictures were developed in 5(13.2%). 21(77.8%) and 48 (81.4%), respectively, with no statistical difference between later two groups. 3. In the cases of urethral stricture who were treated by suprapubic cystostomy as a initial management required more complicated surgical procedures such as end to end anastomosis or staged urethroplasty for the correction than primary realignment. 4. Complications other than stricture such as impotence, urinary tract infection, stone, or fistula were developed in both groups similarly.