Endoscopic urethroplasty ofposterior urethral avulsion

doi:10.1016/S0090-4295(94)80017-0

Urology

Volume 44, Issue 1, July 1994, Pages 100-105

https://doi.org/10.1016/S0090-4295(94)80017-0 Get rights and content

Abstract

Objectives.

Traumatic avulsion of the posterior urethra represents a challenging reconstructive problem that traditionally has been managed by the transpubic or transperineal approach. We report the advantages of endourologic techniques to reconstruct short posterior urethral disruptions based on the principles of establishing proximal urethral control and balloon dilation of the newly constructed urethra.

Methods.

Endourologic urethroplasty consists of: (1) antegrade flexible cystoscopy orantegrade passage of a Goodwin sound, (2) retrograde urethrotomy to light or to tip of Goodwin sound, facilitated by C-arm fluoroscopy, (3) establishment of urethral continuity by passage of a guide wire, (4) balloon dilation of the newly established urethra to 24 to 30 F over a length of 4 cm, and (5) long-term urethral stenting (4 to 8 weeks) with a silicone Foley catheter.

Results.

In four men initially managed by suprapubic cystostomy, endourologic reconstruction was performed. The mean blood loss was 250 mL, and mean length of hospitalization was 5.4 days. All patients were continent and three were potent over a mean follow-up of 10.5 months. Uroflowmetric monitoring showed satisfactory voiding patterns with subsequent minor endoscopic revisions required in three patients.

Conclusions.

The technical advantages of this method include stabilization and identificationof the proximal urethra, intraoperative shortening of the urethral gap to facilitate the urethrotomy, and radial distention of the urethra by balloon dilation. We conclude that endourologic methods provide a safe and effective initial treatment of urethral avulsion.

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Cited by (15)

When to remove the urethral catheter after endoscopic realignment of traumatic disruption of the posterior urethra?
2017, Progres en Urologie
Citation Excerpt :
Endoscopic urethral realignment is a minimally invasive technique that was described for the early management of traumatic posterior urethral disruption [1–3]. In spite of its wide popularity, a high incidence of post-operative urethral stricture developed, sometimes exceeding 50% [2,4–8]. The high incidence was also reported after surgical urethral realignment [9].
To detect the optimal time for urethral stent removal after endoscopic urethral realignment and its effect on the incidence of development of urethral stricture.
Eighteen patients underwent endoscopic urethral realignment after traumatic disruption of the posterior urethra. Post-operative urethroscopy was done using the flexible cystoscope to assess progress of urethral healing. The urethral Foley catheter that served as a stent and for urine drainage was removed only when complete mucosal healing was observed by flexible urethroscopy. There was a post-operative follow-up period of 12–36 months. Uroflowmetry was performed at the end of the follow-up period.
Endoscopy 6 weeks after realignment showed 50–75% mucosal epithelialization at the site of urethral disruption in all patients. Epithelialization was complete at 9 weeks in 15/18 patients (83%) and at 12 weeks in the remaining 3 patients (17%). One patient (5.6%) developed a mild symptomatic stricture 5 months post stent removal that was successfully treated by a single session of visual urethrotomy. All 18 patients had normal uroflowmetry readings at 12–36 months after realignment.
Urethral stenting should be continued till mucosal healing at the site of urethral disruption became complete. Removal of the stent at this optimal time decreases the incidence of post-operative urethral stricture. Flexible urethroscopy was a safe procedure for post-operative follow-up of endoscopic urethral realignment to assess the progress and completion of mucosal healing at the site of realignment.
4.
Déterminer le timing optimal pour l’ablation de la sonde vésicale après réalignement endoscopique de l’urètre et son effet sur l’incidence des sténoses.
Dix-huit patients ont subi un réalignement endoscopique de l’urètre après rupture traumatique de l’urètre postérieur. L’urethroscopie postopératoire a été réalisée en utilisant un cystoscope flexible pour évaluer l’évolution de la cicatrisation urétrale. Le cathéter de Foley urétral qui servait d’endoprothèse et de drainage de l’urine n’a été retiré que lorsque la guérison muqueuse complète avait été observée. Il y a eu une période de suivi postopératoire de 12 à 36 mois. Une débitmétrie a été réalisée à la fin de la période de suivi.
L’endoscopie 6 semaines après le réalignement a révélé une épithélialisation de la muqueuse de 50 à 75 % au site de rupture urétrale chez tous les patients. L’épithélialisation était complète à 9 semaines chez 15/18 patients (83 %) et à 12 semaines chez les 3 patients restants (17 %). Un patient (5,6 %) a développé une sténose symptomatique légère 5 mois après l’ablation de la sonde qui a été traitée avec succès par une seule uréthrotomie endoscopique. Tous les 18 patients ont eu des débit normaux à 12–36 mois après le réalignement.
Le stent urétral doit être poursuivi jusqu’à ce que la cicatrisation de la muqueuse au site de rupture urétrale devienne complète. L’ablation de la sonde à ce moment optimal diminue l’incidence des sténoses urétrales post-opératoires.
4.
Reconstruction of posterior urethral disruption
2002, Urologic Clinics of North America
Traumatic posterior urethral injury and early primary endoscopic realignment: Evaluation of long-term follow-up
1999, Urology
Objectives. The management of complete or partial posterior urethral disruption is controversial and much debate continues regarding immediate versus delayed definitive therapy. We further analyze our experience and long-term results using early endoscopic realignment.
Methods. Between April 1991 and June 1995, 8 men with posterior urethral avulsion, either complete or partial and secondary to blunt trauma and pelvic fractures, presented to our institution. A variety of endourologic techniques were employed to achieve urethral continuity while attempting to minimize stricture formation, incontinence, and impotence.
Results. After a mean of 50.4 months (range 35 to 85) of follow-up, 7 men (87.5%) are continent, with 2 of those requiring intermittent self-dilation ranging from once every 7 days to once a month. One patient required conversion to an open perineal urethroplasty. Of the 8 patients, 5 (62.5%) are potent, and 2 others achieve adequate erections for intercourse using intracorporeal injections. Four of the 8 have required subsequent internal urethrotomies with eventual voiding stabilization over the course of 12 months. Average time to realignment was 9.5 days (range 0 to 19).
Conclusions. Primary endoscopic realignment offers an effective method for treating traumatic urethral injuries. Our long-term follow-up provides further support for use of this technique by demonstrating that urethral continuity can be established without increased incidence of impotence, stricture formation, or incontinence. By achieving early and minimally invasive realignment, we seem to lessen the severity of stricture disease that almost uniformly afflicts those patients who undergo delayed repair. If a minimally invasive technique should fail, it does not seem to delay nor does it preclude further management using open techniques.
Urethral injuries revisited
1996, Injury
Percutaneous retropelvic endopyelotomy for treatment of ureteropelvic junction obstruction
2018, Urology Annals
Pelvic fracture urethral injury in males-mechanisms of injury, management options and outcomes
2018, Translational Andrology and Urology

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Adult urologyEndoscopic urethroplasty ofposterior urethral avulsion

Abstract

Objectives.

Methods.

Results.

Conclusions.

J Urol

J Urol

J Urol

J Urol

J Urol

Urol Clin North Am

Urol Clin North Am

Urology

Adult urology
Endoscopic urethroplasty ofposterior urethral avulsion