Objectives:To assess the effect of redo inferior pubectomy on the management of complicated pelvic fracture urethral injury(PFUI)in patients with a history of failed anastomotic urethroplasty.Materials and methods:We ...Objectives:To assess the effect of redo inferior pubectomy on the management of complicated pelvic fracture urethral injury(PFUI)in patients with a history of failed anastomotic urethroplasty.Materials and methods:We retrospectively reviewed all patients receiving redo anastomotic urethroplasty with redo inferior pubectomy for failed PFUI between January 2010 and December 2021.Patients with incomplete data and those who were lost to follow-up were excluded.Successful urethroplasty was defined as the restoration of a uniform urethral caliber without stenosis or leakage and further intervention.Functional results,including erectile function and urinary continence,were evaluated.Descriptive statistical analyses were then performed.Results:Thirty-one patients were included in this study.Among them,concomitant urethrorectal fistula occurred in 2 patients,and concomitant enlarged bladder neck occurred in 1.The stenosis site was the bulbomembranous urethra in 2 patients and the prostatomembranous urethra in 29.The mean length of urethral stenosis in all patients was 3.1 cm(range,2.0-5.0 cm).After a mean follow-up of 34.6 months,the final success rate was 96.8%.The incidence of erectile dysfunction reached 77.4%(24/31).Normal continence was achieved in 27(87.1%)patients.One patient developed urinary incontinence of gradeⅡrequiring urinary pads because of an enlarged bladder neck.According to the Clavien-Dindo classification,postoperative complications of grade I occurred in 7 patients and gradeⅡin 4.Conclusions:Repeat anastomotic urethroplasty with repeat inferior pubectomy provides reliable success rates for failed PFUI.In complicated cases,it should be known and mastered.展开更多
Bulbar urethral ischemic necrosis(BUIN)is an iatrogenic entity resulting from repeated attempts at performing anastomotic urethroplasty for pelvic fracture urethral injuries.Etiologically speaking,BUIN is related to a...Bulbar urethral ischemic necrosis(BUIN)is an iatrogenic entity resulting from repeated attempts at performing anastomotic urethroplasty for pelvic fracture urethral injuries.Etiologically speaking,BUIN is related to a compromised blood supply of the bulbar urethra,which normally relies on anterograde supply from bulbar arteries and retrograde supply from recurrent branches of dorsal penile arteries,through the glans.At each transection of the bulbar urethra,both the anterograde and retrograde supplies are compromised,increasing the risk of BUIN.Even though this term is widely used among reconstructive urologists,BUIN is orphan of an accepted scientific definition.We aim to report our personal perspective on BUIN,to identify factors associated with its occurrence,and to describe the management options in these patients.展开更多
基金supported by the National Natural Science Foundation of China(no.82100707 and 82270707)Shanghai Municipal Health Commission research project(no.202140191).
文摘Objectives:To assess the effect of redo inferior pubectomy on the management of complicated pelvic fracture urethral injury(PFUI)in patients with a history of failed anastomotic urethroplasty.Materials and methods:We retrospectively reviewed all patients receiving redo anastomotic urethroplasty with redo inferior pubectomy for failed PFUI between January 2010 and December 2021.Patients with incomplete data and those who were lost to follow-up were excluded.Successful urethroplasty was defined as the restoration of a uniform urethral caliber without stenosis or leakage and further intervention.Functional results,including erectile function and urinary continence,were evaluated.Descriptive statistical analyses were then performed.Results:Thirty-one patients were included in this study.Among them,concomitant urethrorectal fistula occurred in 2 patients,and concomitant enlarged bladder neck occurred in 1.The stenosis site was the bulbomembranous urethra in 2 patients and the prostatomembranous urethra in 29.The mean length of urethral stenosis in all patients was 3.1 cm(range,2.0-5.0 cm).After a mean follow-up of 34.6 months,the final success rate was 96.8%.The incidence of erectile dysfunction reached 77.4%(24/31).Normal continence was achieved in 27(87.1%)patients.One patient developed urinary incontinence of gradeⅡrequiring urinary pads because of an enlarged bladder neck.According to the Clavien-Dindo classification,postoperative complications of grade I occurred in 7 patients and gradeⅡin 4.Conclusions:Repeat anastomotic urethroplasty with repeat inferior pubectomy provides reliable success rates for failed PFUI.In complicated cases,it should be known and mastered.
文摘Bulbar urethral ischemic necrosis(BUIN)is an iatrogenic entity resulting from repeated attempts at performing anastomotic urethroplasty for pelvic fracture urethral injuries.Etiologically speaking,BUIN is related to a compromised blood supply of the bulbar urethra,which normally relies on anterograde supply from bulbar arteries and retrograde supply from recurrent branches of dorsal penile arteries,through the glans.At each transection of the bulbar urethra,both the anterograde and retrograde supplies are compromised,increasing the risk of BUIN.Even though this term is widely used among reconstructive urologists,BUIN is orphan of an accepted scientific definition.We aim to report our personal perspective on BUIN,to identify factors associated with its occurrence,and to describe the management options in these patients.
