Treatment of pelvic fractures complicated with urethral rupture via lateral-rectus approach and Pfannenstiel approach / 中华创伤骨科杂志

Objective:To investigate the safety and clinical efficacy of the lateral-rectus approach combined with the Pfannenstiel approach in the treatment of pelvic fractures complicated with urethral rupture.Methods:From January 2013 to June 2021, 20 patients with pelvic fracture complicated with urethral rupture were surgically managed through the lateral-rectus approach and the Pfannenstiel approach at Department of Traumatic Surgery, Center for Orthopaedic Surgery, the Third Hospital Affiliated to Southern Medical University. They were 15 males and 5 females, with an average age of 42 years (from 18 to 55 years). By the Tile classification, there were 11 cases of type B and 9 cases of type C. The first-stage urethral realignment was performed via the Pfannenstiel approach in the supine position after general anesthesia in conjunction with an urologist; at the second-stage, the lateral-rectus approach was used to reduce and fixate the acetabular or pelvic fractures. The operation time, intraoperative blood loss, fracture reduction quality, pelvic functional recovery and complications were documented.Results:In this cohort, the operation time ranged from 80 to 240 min, averaging 140.5 min; the time for simple urethral convergence ranged from 20 to 30 min; the intraoperative blood loss ranged from 400 mL to 2,000 mL, averaging 730 mL. According to the Mears andVelyvis evaluation for fracture reduction quality, anatomical reduction was achieved in 13 cases, satisfactory reduction in 6 cases, and unsatisfactory reduction in one. The 20 patients were followed up for 12 to 68 months (mean, 37 months) after surgery. One fracture got nonunited but the other fractures got united after 3.0 to 4.5 months (mean, 3.5 months). According to the Majeed scoring system, the pelvic function at 12 months after surgery was excellent in 12 cases, good in 6 and fair in 2, giving an excellent and good rate of 90% (18/20). Screw loosening was found in one patient, traction injury to the lumbosacral trunk nerve in another patient, varying degrees of dysuria which responded to periodic urethral dilation in 8 patients, urethral stricture in 3 patients and erectile dysfunction in 5 patients. No abdominal hernia or pelvic infection was observed.Conclusions:The lateral-rectus approach combined with the Pfannenstiel approach can be used effectively to reduce and fixate the pelvic and acetabular fractures, and to repair the urethral rupture in one stage as well. They are also safe due to a low incidence of such complications as abdominal wall hernia and pelvic infection.

Endoscopic realignment with drainage via a peel-away sheath for the treatment of urethral rupture: A report of 21 cases / 中华男科学杂志

<p><b>Objective</b>To study the clinical effect endoscopic realignment with drainage via a peel-away sheath in the treatment of urethral rupture.</p><p><b>METHODS</b>We treated 21 urethral rupture patients by endoscopic realignment with drainage via a peel-away sheath using normal saline for irrigation under the normal nephroscope or Li Xun nephroscope, followed by analysis of the clinical results.</p><p><b>RESULTS</b>The operation was successfully accomplished in 20 cases but failed in 1 and none experienced urinary extravasation. In the 14 cases of bulbar urethral rupture, the mean operation time was (5.1±1.6) min and the mean Foley catheter indwelling time was (26.0±5.1) d. Urethral stricture developed in 57.1% (8/14) of the cases after catheter removal, of which 1 was cured by internal urethrotomy and the other 7 by urethral sound dilation, with an average maximum urinary flow rate of (18.8±1.8) ml/s at 12 months after operation. In the 6 cases of posterior urethral rupture, the mean operation time was (15.8±7.5) min and the mean Foley catheter indwelling time was 8 weeks. Urethral stricture developed in all the 6 cases after catheter removal, of which 3 cases were cured by urethral dilation, 1 by internal urethrotomy, and 2 by open urethroplasty. The average maxium urinary flow rate of the 4 cases exempt from open surgery was (17.9±1.9) ml/s at 12 months after operation.</p><p><b>CONCLUSIONS</b>Endoscopic realignment with drainage via a peel-away sheath can keep the operative field clear, avoid intraoperative rinse extravasation, shorten the operation time, improve the operation success rate, and achieve satisfactory early clinical outcomes in the treatment of either bulbar or posterior urethral rupture.</p>

Emergency treatment of pelvic fracture complicated with traumatic rupture of urethra and bladder / 中国综合临床

ObjectiveTo investigate emergency diagnosis and treatment of pelvic fracture complicated with traumatic rupture of urethra and bladder,and to improve the success rate of treatment on pelvic fracture.MethodsClinical data of 52 cases of pelvic fracture complicated with traumatic rupture of urethra and bladder in department of emergency and urology from 2000 to 2010 was retrospectively analyzed.Results Among the 52 patients,there was 41 cases of pelvic fracture complicated with posterior urethral disruption,15 cases complicated with rupture of bladder and 4 cases complicated withtraumatic rupture of urethra and bladder at the same time.In 41 cases with posterior urethral rupture,6 individual's condition were relatively so severe that they onlyunderwent bladder puncture nephrostomy,and 29 cases underwent traction urethral realignment,the other 6 cases didn't undergo surgery; In 15 cases of patients with bladder rupture,2 patients were performed urethral realignment and bladder repair,11 patients underwent the bladder repair only and the other 2 patients were not performed surgery.There were 8 patients died and the mortality rate was 15.4％.Six died cases failed to conduct emergency surgery because of uncontrollable bleeding and another 2 cases died due to multiple organ failure.ConclusionPelvic fractures is a disease with more complications,it should be diagnosed as early as possible.Patients invalid for conventional anti-shock should be performed pelvic external fixation and emergency embolization to stop bleeding in the emergency department,and undergo associated processing after they are in stable condition.

Early Urethroscopic Realignment of Ruptured Bulbous Urethra / 대한비뇨기과학회지

PURPOSE: To evaluate the efficacy of early urethroscopic realignment compared to initial suprapubic cystostomy in the management of bulbous urethral rupture caused by straddle injury. MATERIALS AND METHODS: From May 1995 to June 1996, early urethroscopic realignment was attempted on 16 consecutive patients with bulbous urethral rupture caused by straddle injury. These results were compared with those of 10 consecutive such patients who were managed initially with suprapubic cystostomy between July 1994 and April 1995. RESULTS: Thirteen of the 16 patients(81%), including 1 with a complete rupture, had successful early urethroscopic realignment of the urethra and catheter placement. Ten of these 13 patients(77%), including 9 of 12 partial ruptures and 1 of 1 complete rupture, did not develop stricture after catheter removal. Of the 6 patients with partial rupture who were managed with initial suprapubic cystostomy, 2(33%) had no secondary stricture. All 4 patients with complete rupture managed with initial suprapubic cystostomy alone had resulting stricture. CONCLUSIONS: Early urethroscopic realignment of the ruptured urethra is a simple, safe, rapid, and nontraumatic technique that can be done with sedation and intraurethral topical anesthesia, It reduces the incidence of secondary urethral stricture compared with initial suprapubic cystostomy alone. Therefore, it could be a valuable alternative in the management of bulbous urethral rupture caused by straddle injury.

Endoscopically Guided Primary Urethral Realignment as a Treatment of Anterior Urethral Rupture / 대한비뇨기과학회지

Between Aug. 1985 and Dec. 1995, among 18 patients with trauma of anterior urethra 7 were treated by an endoscopically guided primary urethral realignment under intravenous injection of analgesics. Of the 5 partial ruptures, 3 had excellent results without stricture from 2 months to 4 years (mean 13 months) and resulted in 23-37ml/sec maximal uroflow rate. Then 2 had focal urethral stricture, which could be easily treated with endoscopic internal urethrotomy. Before endoscopically guided primary urethral realignment was done, 6 urethral ruptures without pelvic bone fracture partial rupture 3 cases, complete rupture 3 cases) were performed suprapubic cystostomy and urethroplasty stepwise. We experienced urethral stricture in 6 cases, then performed endoscopic internal urethrotomy and urethroplasty. 4 cases of urethral rupture with pelvic bone fracture partial rupture 1 case, complete rupture 3 cases) were performed suprapubic cystostomy and primary urethroplasty, then there were urethral stricture in all 4 cases. This method offers simpler and more effective than conventional methods without pelvic bone fracture under intravenous injection of analgesics.

Results of endoscopically guided foley catheterization as a treatment of urethral rupture / 대한비뇨기과학회지

Endoscopically guided Foley catheterization was performed as an initial management of 32 patients with anterior urethral rupture and 7 patients with posterior urethral rupture during 6 years from December 1985 to April 1992. The duration of indwelling of the catheter was proportion to the degree and extent of the rupture. As a complication, urethral stricture was developed in 12 patients with anterior urethral rupture (8 patients with partial rupture and 4 patients with complete rupture), and 2 patients with posterior urethral rupture. The complication could be treated with endoscopic internal urethrotomy and some sounding with ease. We suggest that initial procedure have some profit as availability. simplicity. economy, reproducibility and diagnostic accuracy. And so, we would like to recommend this procedure as a initial management of urethral rupture.

Two cases of primary urethral end to end anastomosis for posterior urethral rupture / 대한비뇨기과학회지

There were two cases of posterior urethral ruptured patient combined with severe pelvic bone disruption. They were treated with primary urethral end to end anastomosis and the results were good. We recommend the primary end to end anastomosis of posterior urethral rupture in some instances those who are ready for good exposure of posterior urethra because of wide pelvic bone disruption favorable patient`s condition and excellent skill of surgeon.

Endoscopically Guided primary Catheterization as a Treatment of Anterior Urethral Rupture / 대한비뇨기과학회지

An endoscopically guided primary catheterization under local anesthesia was performed as an initial management of 11 patients with ant. urethral rupture, beginning Dec., 1985. According to the degree and extent of the trauma, endoscopically viewed, the duration of indwelling of the catheter varied from 8 to 30 days. Of the 9 partial ruptures, 7 have excellent results without stricture and 2 have short urethral stricture of 3mm length. Of the 11 ruptures, 2 were complete and resulted in 5mm length of short stricture, which can be easily treated with Endoscopic Internal Urethrotomy.

Experience of 191 Cases of Urethral Rupture and Stricture / 대한비뇨기과학회지

A clinical evaluation was made on 191 patients with urethral rupture and stricture, who had been admitted to the department of Urology during l3 years from l972 to 1984. We have tried the various methods in management of urethral rupture and stricture, such as 1) simple traction by balloon catheter 2) end-to-end anastomosis 3) perineal traction on the prostate 4) immediate cystostomy, and delayed urethroplasty in urethral rupture; 5) urethral dilatation 6) internal urethrotonry 7) end-to-end anastomosis 8) pull-through urethroplasty 9) transpubic urethroplasty 1O) scrotal inlay urethroplasty 11) perineal skin flap urethroplasty in urethral stricture. Especially, we have compared the primary realignment of urethral rupture with delayed urethroplasty Primary realignment with perineal traction on the prostate was most excellent in management of complete posterior urethral rupture, which had a low morbidity, complication, and cost. Immediate cystostomy, and delayed end-to-end anastomosis was good in management of complete anterior urethral rupture. We thought that the difference of result after primary. realignment or delayed urethroplasty of urethral rupture did not depend upon the alternative of them but the degree of urethral injury, surgeon's skill and the adequate application of them according to the state of patients at the time of urethral injury.