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Transpubic approach for lower urinary tract surgery: a 15-year experience
M Golimbu1, S al-Askari, P Morales
1Department of Urology, New York University School of Medicine, New York.
The Journal of Urology
|January 1, 1990
Summary
Partial pubectomy offers a safer alternative to total pubectomy for lower urinary tract surgeries. This transpubic approach improves surgical access while minimizing complications like bleeding and incontinence.
Area of Science:
- Urology
- Surgical Oncology
- Anatomy
Background:
- The symphysis pubis can impede surgical access to lower urinary tract organs.
- A transpubic approach has been utilized to enhance surgical exposure since 1972.
Purpose of the Study:
- To evaluate the efficacy and safety of the transpubic approach using different pubectomy techniques for lower urinary tract surgeries.
- To compare complication rates associated with total versus partial pubectomy.
Main Methods:
- A retrospective review of 287 patients undergoing transpubic surgery for various lower urinary tract conditions.
- Classification of pubectomy into total, partial superior, and partial inferior types based on surgical targets.
- Analysis of surgical outcomes and complications for each pubectomy type.
Main Results:
- The transpubic approach provided valuable exposure for conditions like posterior urethral strictures and bulky tumors.
- Total pubectomy (137 patients) was associated with significant complications, including bleeding, pelvic instability, and incontinence, leading to its abandonment in 1978.
- Partial pubectomy (150 patients) yielded comparable surgical exposure with markedly fewer complications.
Conclusions:
- Partial pubectomy is a safe and effective alternative to total pubectomy for the transpubic approach in complex lower urinary tract surgeries.
- The transpubic approach, particularly with partial pubectomy, offers improved surgical maneuverability and outcomes in challenging cases.