MANAGEMENT OF PELVIC FRACTURE URETHRAL DISTRACTION DEFECT (PFUDD)

INTRODUCTION: Posterior pelvic fracture urethral distraction defect is a challenging urologic problem that may result in complications such as urinary incontinence and inability to void due to recurrent stricture leading to a lifelong disabling condition. AIMS AND OBJECTIVES: To evaluate the outcome of primary realignment after pelvic fracture urethral injury and the outcome of urethroplasty after development of urethral stricture. To study the outcome of simple trocar spc after pelvic fracture urethral injury and the results of stricture management. To compare the results of primary realignment versus simple trocar spc after pelvic fracture urethral injury. MATERIALS AND METHODS: 50 patients with pelvic fracture urethral injury who attended emergency department were included in the study. All patients were subjected to RGU, USG and CECT Abdomen with delayed films in selected cases with high probability of rectal, bladder neck injury. In our study subjects undergoing primary catheter realignment are included in group A. and those undergoing simple emergency SPC are included in group B. Both were followed up for the development of complications and managed accordingly. RESULTS: Out of 50 patients with pelvic fracture 26 (52%) were in in 2030 years age group. Trocar SPC was done in 40 patients (80%) and managed conservatively. They are grouped as Group B. All of them underwent RGU after three weeks. When there was no demonstrable stricture, suprapubic catheter was clamped and voiding trial given. If the patient was not voiding well, SPC catheter continued for 3-6 months until the healing of orthopedic injuries. If RGU shows stricture, SPC catheter is continued for 3-6 months. Patients with total block underwent combined RGU and VCUG (up and downogram) before planning for delayed urethroplasty. The remaining 10 patients (20%) were included in Group A who underwent primary catheter realignment simultaneously when laparotomy is done for other indications like rectal injury, bladder neck injury or internal fixation for pelvic fracture. In group A after primary realignment, 70% developed posterior urethral structure. All of them underwent progressive perineal urethroplasty. In group B after Trocar SPC, 95% developed post urethral stricture out of which 82.5% underwent progressive perineal urethroplasty and 12.5% needed perineoabdominal urethroplasty. CONCLUSION: Trocar SPC followed by delayed urethroplasty is the choice of treatment for PFUDD except in few selected cases where primary urethral realignemt in necessary.