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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Rupture of the male membranous urethra
M S Khan1, J A Thornhill, R Grainger
1Urology Department, Adelaide & Meath Hospital, Incorporating The National Children's Hospital, Tallaght, Dublin, Ireland.
Traumatic urethral rupture management is debated. Early surgical realignment offers better outcomes for stable patients, while unstable patients benefit from delayed urethroplasty, reducing long-term complications like strictures.
Area of Science:
- Urology
- Trauma Surgery
Background:
- Management of traumatic rupture of the male membranous urethra is controversial.
- Long-term morbidity includes urinary incontinence, urethral stricture, and erectile dysfunction.
Purpose of the Study:
- To review management and outcomes of urethral rupture.
- To improve treatment protocols for traumatic urethral injuries.
Main Methods:
- Retrospective study of 47 patients with traumatic urethral rupture over 25 years.
- Analysis of outcomes based on surgical intervention: emergency suprapubic catheterisation, early open surgical realignment, delayed transabdominal transpubic urethroplasty, and cystoscopic management.
Main Results:
- Early open surgical realignment (1-2 weeks) in 32 patients resulted in 78% stricture formation.
- Delayed urethroplasty (3 months) in 10 patients had a 40% stricture rate.
- Erectile dysfunction correlated with initial injury severity, not treatment method.
Conclusions:
- Immediate urethral realignment is recommended for stable patients requiring emergency laparotomy for other injuries.
- Early realignment can be combined with pelvic fracture fixation.
- Delayed urethroplasty at three months is advised for unstable patients with associated injuries.
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