Management of Pelvic Fracture Urethral Injury: Is Supracrural Urethral Rerouting (Step 4) Becoming Anecdotical or Does It Remain in Force?

被引:2
|
作者
Yepes, Christian [1 ]
Oszczudlowski, Maciej [2 ]
Bandini, Marco [3 ]
Joshi, Pankaj M. [1 ]
Alrefaey, Ahmed [1 ]
Bhadranavar, Shreyas [1 ]
Martins, Francisco E. [4 ]
Kulkarni, Sanjay B. [1 ]
机构
[1] Kulkarni Reconstruct Urol Ctr, Dept Urol, Pune 411045, India
[2] Ctr Postgrad Med Educ, Urol Clin, PL-01813 Warsaw, Poland
[3] Univ Vita Salute San Raffaele, San Raffaele Hosp, Urol Res Inst URI, Unit Urol, I-20132 Milan, Italy
[4] Univ Lisbon, Hosp Santa Maria, Sch Med, Dept Urol, P-1649028 Lisbon, Portugal
关键词
posterior urethra; pelvic fracture urethral injury; perineal approach; transpubic approach; anastomotic urethroplasty; supracrural urethral rerouting; DISTRACTION DEFECT; DISRUPTION; PERINEAL; REPAIR; RECONSTRUCTION; URETHROPLASTY; EXPERIENCE; ANATOMY;
D O I
10.3390/jcm12062427
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Webster described a step-based perineal approach for repairing the posterior urethra in patients with pelvic fracture urethral injury (PFUI). The higher the complexity of the step, the higher the morbidity for the patient and the lower the surgical outcomes. We evaluated the outcomes of anastomotic urethroplasty (especially Step 4 or higher) or substitution urethroplasty in patients with PFUI at our center. Between 2013 to 2021, we retrospectively collected data on patients with PFUI. Surgical procedures were categorized according to the Webster classification and rates of each step were reported. The success rate was defined as Qmax above 10 mL/s and no need for further treatment. In this period, 737 male patients with PFUI were surgically treated. Notably, 18.8%, 17.6%, 46%, 1.8%, and 5.6% of included patients received steps 1, 2, 3, and 4 and the abdominoperineal approach, respectively. In 68 (9.2%) patients, the substitution of urethroplasty with a pedicled preputial tube (PPT) was needed. The success rate was 69.2% in Step 4, 74.4% in the abdominoperineal approach, and 86.4% in PPT; however, recurrence-free survival was not significantly different between groups (p = 0.22). Step 4 perineal anastomotic urethroplasty represents a surgical option in the armamentarium of PFUI treatment. Indications should be carefully reviewed to improve patient selection and avoid surgical failure, stopping at the step which first gives a tension-free anastomosis.
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页数:10
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