Objective:To determine possible factors that may increase the complexity of reconstruction of pelvic fracture urethral injury.Prediction of complex repair helps in adequate patient counseling and preparation,and possi...Objective:To determine possible factors that may increase the complexity of reconstruction of pelvic fracture urethral injury.Prediction of complex repair helps in adequate patient counseling and preparation,and possible referral to high-volume reconstructive surgeons.Methods:A series of 30 adult male patients with pelvic fracture urethral injury underwent delayed posterior urethroplasty between January 2021 and December 2023 at the Assiut University Hospital and data were collected from medical records.Retrograde urethrography with voiding cystourethrogram was done 3 months after trauma.Defect length was measured and bladder neck position was verified.Urethroplasty was done using an elaborate perineal approach with inferior wedge pubectomy done in select cases.Results:Patients’ages ranged from 19 years to 53 years(median 34 years).The overall success rate of urethroplasty was 80%.Displacement of the bladder neck from the midline was significantly associated with prolonged operative time(p=0.004)and increased blood loss(p=0.002).There were strong positive correlations between preoperative defect length and operative time(r_(s)=0.84)as well as blood loss(r_(s)=0.78),which were statistically significant(p=0.001).Conclusion:Lateral bladder neck displacement and longer defect length in preoperative retrograde urethrogram were significantly associated with difficult urethroplasty for pelvic fracture urethral injury.展开更多
Objectives To evaluate the pubourethral stump angle(PUA)to determine the site of urethral transection during transperineal anastomotic urethroplasty(TAU).Patients and methods Patients diagnosed with pelvic fracture ur...Objectives To evaluate the pubourethral stump angle(PUA)to determine the site of urethral transection during transperineal anastomotic urethroplasty(TAU).Patients and methods Patients diagnosed with pelvic fracture urethral distraction defect who underwent preoperative magnetic resonance(MR)urethrography and were treated with TAU between June 2019 and December 2021 were retrospectively reviewed.According to the site of urethral transection during TAU,patients were classified into proximal and distal groups receiving TAU with proximal and distal transection,respectively.The demographic and clinical data were recorded.The PUA was measured on sagittal T2-weighted MR urethrography.The relationship between the site of urethral transection and PUA was analyzed.Results Sixty-seven patients were included.Forty-one and 26 patients were included in the proximal and distal groups,respectively.Finally,the success rates in the proximal and distal groups were 95.1%and 92.3%,respectively.The PUAs were 123.7°±14.6°and 86.5°±9.8°(p=0.005),respectively.The curves for the 2 groups intersected between 90°and 110°.The scribing effects at 90°,100°,and 110°in the 2 groups were compared in detail.Compared with 90°and 110°,100°had the highest sensitivity as the demarcation line.Conclusions In the treatment of pelvic fracture urethral distraction defect,the PUA on MR urethrography is an objective and valid parameter for evaluating the site of urethral transection during TAU.A PUA>100°indicates that proximal transection should be preferentially attempted.展开更多
文摘Objective:To determine possible factors that may increase the complexity of reconstruction of pelvic fracture urethral injury.Prediction of complex repair helps in adequate patient counseling and preparation,and possible referral to high-volume reconstructive surgeons.Methods:A series of 30 adult male patients with pelvic fracture urethral injury underwent delayed posterior urethroplasty between January 2021 and December 2023 at the Assiut University Hospital and data were collected from medical records.Retrograde urethrography with voiding cystourethrogram was done 3 months after trauma.Defect length was measured and bladder neck position was verified.Urethroplasty was done using an elaborate perineal approach with inferior wedge pubectomy done in select cases.Results:Patients’ages ranged from 19 years to 53 years(median 34 years).The overall success rate of urethroplasty was 80%.Displacement of the bladder neck from the midline was significantly associated with prolonged operative time(p=0.004)and increased blood loss(p=0.002).There were strong positive correlations between preoperative defect length and operative time(r_(s)=0.84)as well as blood loss(r_(s)=0.78),which were statistically significant(p=0.001).Conclusion:Lateral bladder neck displacement and longer defect length in preoperative retrograde urethrogram were significantly associated with difficult urethroplasty for pelvic fracture urethral injury.
基金National Natural Science Foundation of China(grant numbers:82100707 and 82270707)Shanghai Municipal Health Commission research project(grant number:202140191).
文摘Objectives To evaluate the pubourethral stump angle(PUA)to determine the site of urethral transection during transperineal anastomotic urethroplasty(TAU).Patients and methods Patients diagnosed with pelvic fracture urethral distraction defect who underwent preoperative magnetic resonance(MR)urethrography and were treated with TAU between June 2019 and December 2021 were retrospectively reviewed.According to the site of urethral transection during TAU,patients were classified into proximal and distal groups receiving TAU with proximal and distal transection,respectively.The demographic and clinical data were recorded.The PUA was measured on sagittal T2-weighted MR urethrography.The relationship between the site of urethral transection and PUA was analyzed.Results Sixty-seven patients were included.Forty-one and 26 patients were included in the proximal and distal groups,respectively.Finally,the success rates in the proximal and distal groups were 95.1%and 92.3%,respectively.The PUAs were 123.7°±14.6°and 86.5°±9.8°(p=0.005),respectively.The curves for the 2 groups intersected between 90°and 110°.The scribing effects at 90°,100°,and 110°in the 2 groups were compared in detail.Compared with 90°and 110°,100°had the highest sensitivity as the demarcation line.Conclusions In the treatment of pelvic fracture urethral distraction defect,the PUA on MR urethrography is an objective and valid parameter for evaluating the site of urethral transection during TAU.A PUA>100°indicates that proximal transection should be preferentially attempted.
