Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experience
Introduction: The optimal management strategy for urethral injuries remains controversial. Suprapubic cystostomy followed by delayed urethral reconstruction or immediate primary urethral injury repair is associated with high complication rate. Early endoscopic realignment for urethral injuries provi...
Main Author: | |
---|---|
Format: | Article |
Language: | English |
Published: |
Wolters Kluwer Medknow Publications
2018-01-01
|
Series: | Urology Annals |
Subjects: | |
Online Access: | http://www.urologyannals.com/article.asp?issn=0974-7796;year=2018;volume=10;issue=1;spage=47;epage=51;aulast=El |
id |
doaj-6b4f13aa61fa4f41a92ff81b04d17fa2 |
---|---|
record_format |
Article |
spelling |
doaj-6b4f13aa61fa4f41a92ff81b04d17fa22020-11-25T00:24:46ZengWolters Kluwer Medknow PublicationsUrology Annals0974-77960974-78342018-01-01101475110.4103/UA.UA_151_17Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experienceHamed Mohamed El DarawanyIntroduction: The optimal management strategy for urethral injuries remains controversial. Suprapubic cystostomy followed by delayed urethral reconstruction or immediate primary urethral injury repair is associated with high complication rate. Early endoscopic realignment for urethral injuries provides early definitive procedure with low complications and avoids the need for further urethral reconstruction. Materials and Methods: Between April 2007 and March 2016, 27 patients with traumatic posterior urethral disruptions were reviewed. All patients were managed by endoscopic urethral realignment. Patients were followed up every 3 months for 18–36 months regarding incontinence, potency, and urine flow. Results: Endoscopic urethral realignment was performed immediately in 21 patients and was delayed in 6 patients. It was successful in 24/27 (88.8%) patients. During the procedure, the proximal urethral end was identified directly in four patients, and by the guidance of methylene blue injection, guidewire or endoscopic light in three, nine, and eight patients, respectively. The Foley catheter was removed after 9 weeks in 17/24 (70.8%) patients and after 12 weeks in 7/24 (29.2%) patients. Six months after realignment, minimal urethral stricture was developed in 4/24 (16.7%) patients. All of them were treated successfully with single session of internal urethrotomy without recurrence after 1-year follow-up. After 18–36-month follow-up period, all patients were potent, continent, and with satisfactory voiding pattern. Conclusions: Endoscopic primary realignment of posterior urethral rupture is less invasive and a safer procedure, without pelvic hemorrhage or additional injuries. It has low incidence of severe urethral stricture and avoids the need for delayed open urethral reconstruction.http://www.urologyannals.com/article.asp?issn=0974-7796;year=2018;volume=10;issue=1;spage=47;epage=51;aulast=ElUrethraurethral disruptionurethral realignmenturethral stentingurethral stricture |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hamed Mohamed El Darawany |
spellingShingle |
Hamed Mohamed El Darawany Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experience Urology Annals Urethra urethral disruption urethral realignment urethral stenting urethral stricture |
author_facet |
Hamed Mohamed El Darawany |
author_sort |
Hamed Mohamed El Darawany |
title |
Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experience |
title_short |
Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experience |
title_full |
Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experience |
title_fullStr |
Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experience |
title_full_unstemmed |
Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experience |
title_sort |
endoscopic urethral realignment of traumatic urethral disruption: a monocentric experience |
publisher |
Wolters Kluwer Medknow Publications |
series |
Urology Annals |
issn |
0974-7796 0974-7834 |
publishDate |
2018-01-01 |
description |
Introduction: The optimal management strategy for urethral injuries remains controversial. Suprapubic cystostomy followed by delayed urethral reconstruction or immediate primary urethral injury repair is associated with high complication rate. Early endoscopic realignment for urethral injuries provides early definitive procedure with low complications and avoids the need for further urethral reconstruction.
Materials and Methods: Between April 2007 and March 2016, 27 patients with traumatic posterior urethral disruptions were reviewed. All patients were managed by endoscopic urethral realignment. Patients were followed up every 3 months for 18–36 months regarding incontinence, potency, and urine flow.
Results: Endoscopic urethral realignment was performed immediately in 21 patients and was delayed in 6 patients. It was successful in 24/27 (88.8%) patients. During the procedure, the proximal urethral end was identified directly in four patients, and by the guidance of methylene blue injection, guidewire or endoscopic light in three, nine, and eight patients, respectively. The Foley catheter was removed after 9 weeks in 17/24 (70.8%) patients and after 12 weeks in 7/24 (29.2%) patients. Six months after realignment, minimal urethral stricture was developed in 4/24 (16.7%) patients. All of them were treated successfully with single session of internal urethrotomy without recurrence after 1-year follow-up. After 18–36-month follow-up period, all patients were potent, continent, and with satisfactory voiding pattern.
Conclusions: Endoscopic primary realignment of posterior urethral rupture is less invasive and a safer procedure, without pelvic hemorrhage or additional injuries. It has low incidence of severe urethral stricture and avoids the need for delayed open urethral reconstruction. |
topic |
Urethra urethral disruption urethral realignment urethral stenting urethral stricture |
url |
http://www.urologyannals.com/article.asp?issn=0974-7796;year=2018;volume=10;issue=1;spage=47;epage=51;aulast=El |
work_keys_str_mv |
AT hamedmohamedeldarawany endoscopicurethralrealignmentoftraumaticurethraldisruptionamonocentricexperience |
_version_ |
1725351847177224192 |