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| Treatment of posterior urethral distractions defects following pelvic fracture |
Emilio Ríosa*( ),Luís Martínez-Pi?eirob
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a Department of Urology, Universitary Hospital Infanta Sofia, Madrid, Spain
b Department of Urology, Universitary Hospital La Paz, Madrid, Spain |
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Abstract Posterior urethral injuries typically arise in the context of a pelvic fracture. Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected. Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first. Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction. The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury. Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3-6 months continues to be the gold standard of treatment. In this paper, we provide a comprehensive review of the literature with a special emphasis on the various treatments available: Open or endoscopic primary realignment, immediate or delayed urethroplasty after suprapubic cystostomy, and delayed optical urethrotomy.
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Received: 15 February 2017
Published: 23 July 2018
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Corresponding Authors:
Ríos Emilio
E-mail: erios00@hotmail.com
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Butterfly fracture.
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| Type of fracture | Probability | | Single ramus | 0.64 | | Ipsilateral rami | 0.76 | | Malgaigne (ramus and ipsilateral sacroiliac) | 3.40 | | Butterfly | 3.85 | | Butterfly and sacroiliac | 24.02 |
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Posterior urethra fracture. Combined urethrography.
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Bulbar urethra stricture after primary realignment.
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Bulbar urethra stricture after primary realignment. End-to-end urethroplasty.
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| Clinical series | No. of patients | Follow-up, months (range) | Erectile dysfunction, n (%) | Incontinence n (%) | Stricture ratean (%) | | Gibson, 1974 [17] | 35b | NA | 12 (34) | 1 (3) | 26 (74) | | Crassweller et al., 1977 [18] | 38 | 24-240 | 19/42 (45) | NA | 12 (32) | | Follis et al., 1992 [19] | 20 | 42 (1-360) | 4 (20) | 2 (10) | 12 (60) | | El-Abd, 1995 [20] | 44 | NA | 35 (79) | 0 | 44 (100) | | Elliott and Barret, 1997 [14] | 53 | 126 (1-120) | 11 (21) | 2 (4) | 36 (68) | | Porter et al., 1997 [21] | 10 | 10.9 (2-31) | 1/7 (14) | 0 | 5 (50) | | Tahan et al., 1999 [22] | 13 | 29 | 3 (23) | 0 | 5 (39) | | Asci et al., 1999 [23] | 20 | 39 (19-78) | 4 (20) | 2 (10) | 9 (45) | | Moudouni et al., 2001 [24] | 23 | 68 (18-155) | 4/29 (14) | 0 | 16 (70) | | Mouraviev et al., 2005 [16] | 57 | 105 (12-264) | 19 (34) | 10 (18) | 28 (49) | | Leddy et al., 2012 [25] | 19 | 40 (10-80) | 4/18 (22.2) | 0 | 15 (78.9) | | Johnsen et al., 2015 [26] | 27 | 40 (1-152) | 21 (78) | 2 (9) | 17 (63) |
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Separation of the corpora cavernosa.
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| Clinical series | No. of patients | Follow-up, months (range) | Repeated urethrotomy, n (%) | Erectile dysfunction, n (%) | | Gupta and Gill 1986 | 10 | 15.1 (6-24) | 10 (100) | 0 | | Chiou et al., 1988 | 8 | 43 (12-79) | 7 (88) | 0 | | Marshall 1989 | 10 | NA | 10 (100) | 0 | | Barry 1989 | 12 | 22 (1.5-85) | 6 (50) | 0 | | DeVries and Anderson 1990 | 4 | <4 | 1 (25) | 0 | | Leonard et al., 1990 | 3 | 31 (13-51) | 1 (33) | 0 | | Kernohan et al., 1991 | 7 | 35 (21-84) | 7 (100) | 0 | | Yasuda et al., 1991 | 17 | 44 (12-96) | 7 (41) | 0 | | Quint &Stanisic 1993 | 10 | 43 (7-108) | 6 (60) | 0 | | El-Abd 1995 | 284 | NA | 272 (96) | 0 | | Goel et al., 1997 | 13 | 17.7 (11-24) | 10 (77) | NA | | Levine and Wessells 2001 | 6 | 60 | 6 (100) | NA | | Dogra and Nabi 2002a | 61 | 30 (9-44) | 11 (18) | NA | | total | 445 | | 354 (80) | |
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