Introduction and Objectives
Management of posterior urethral distraction injuries with a pelvic fracture are a challenge for urologic surgeons. The goal of resolving a prostatomembranous urethral injury is to provide a patent urethra with no additional complications. Suprapubic cystostomy placement with delayed surgical urethral reconstruction is the treatment of choice.
Material and Methods
Between March 2006 and January 2009 8 patients (range 40–64 years) with posterior urethral distraction injury were treated at our department. After retrograde uretrogram with presence of complete posterior urethral rupture a suprapubic cystostomy was inserted. 5 patients had also a pelvic fracture. The mean time to delayed anastomotic posterior urethroplasty was 6.5 months (range 4–8). Perineal anastomotic urethroplasty was peformed in 7 patients and abdominoperineal in 1 patient. We separated penile corporal bodies in every case to achieve tension free bulboprostatic anastomosis with 8 sutures. A nose speculum was used to open prostatic apex and insert stitches from outside in, including the mucosa tissue. An urethral catheter was removed after 30 days. A suprapubic cystostomy was removed after spontaneous voiding with residual urine under 100 ml.
Median follow up was 16 months (6–24). There were no operative and early postoperative complications. 1 patient noticed decrease of erectile function after removal of catheters. All patients are continent. Patients were followed up with uroflowmetry 3m., 6m. and 12m. after reconstruction of urethra. 5 patients had satisfactory uroflowmetry with median Qmax. 16 ml/s at 3 m. and 15 ml/s at 12 m. 3 patients were treated with addition internal urethrotomy. 2 of them developed short stricture with decrease in Qmax. They were treated with internal urethrotomy 3 m. and 8 m. after anastomotic urethroplasty. Our first patient treated with delayed urethroplasty developed acute urinary retention 2 weeks after removal of catheters. He was treated with internal urethrotomy 2 weeks, 2m., 4m. and 6m. after acute urinary retention. Patients with additional internal urethrotomy had Qmax. 19 ml/s after 3m. and Qmax. 17 ml/s after 12m. There were no need for second urethroplasty.
We changed our therapevtic approach from early catheter-assisted realignment to suprapubic cystostomy and delayed urethral reconstruction. With experiences in reconstructive urethral surgery is this treatment safe with good long term results.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.