Hinged Transpubic Approach to Delayed Repair of Posterior Urethral Distraction Defects Complicating Pelvic Fractures - Preliminary Experience

ABSTRACT

Objective: To present our experience with a transpubic approach to the management of one of the most challenging injuries of the lower urinary tract. Patients and Methods: Between January 2003 and December 2005; 7 patients presenting to our unit with complex urethral distraction defects due to type 2 or 3 posterior urethral disruption injuries complicating pelvic fracture were included in an ongoing evaluation of the transpubic approach to the repair of such defects. The patients had a mean age of 37.7 (range 22 - 56) years and were followed up for 1 - 4 years. Results: After the follow-up period 4 patients had a very successful outcome with trouble-free voiding. Three developed stric-tures; two of which were successfully managed with regular dilatation; while the third patient became catheter-dependent following dilatation and inadvertent creation of a false passage. This patient underwent a successful re-operation with full recovery. Conclusion: The transpubic approach to delayed repair of urethral distraction defects complicating pelvic fracture is feasible. It allows an effective dissection of the dense hematoma-fibrosis that commonly complicates these injuries at a later stage. The approach is particularly useful in complex long-standing defects where such dissection is made relatively easy by the ample working space provided. The successful outcome of treatment by this approach in 4 and ultimately 5 out of 7 patients offers a reasonable degree of salvage for patients with an otherwise poor prognosis. Further studies are warranted to confirm our positive results: