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Vessel-sparing Excision and Primary Anastomosis
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Early endoscopic realignment in posterior urethral injuries.

B Shrestha1, J L Baidya

  • 1Department of Urology and General Surgery, B and B Teaching Hospital, Kathmandu, Nepal. drbinshrestha@gmail.com

Journal of Nepal Health Research Council
|June 22, 2013
PubMed
Summary

Early endoscopic realignment effectively treats complete posterior urethral injuries, showing low rates of incontinence and erectile dysfunction. This minimally invasive approach offers a successful management option for traumatic urethral rupture.

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Area of Science:

  • Urology
  • Trauma Surgery
  • Reconstructive Surgery

Background:

  • Posterior urethral injury necessitates specialized tertiary care for successful management.
  • Pelvic fractures frequently involve posterior urethral injuries, requiring expert intervention.
  • Endoscopic realignment is a key technique in managing these complex injuries.

Purpose of the Study:

  • To evaluate the outcomes of early endoscopic realignment in patients with complete posterior urethral rupture.
  • To assess the efficacy and complication rates of this minimally invasive approach.

Main Methods:

  • A prospective study included 20 patients with complete posterior urethral rupture due to blunt pelvic trauma.
  • Diagnosis was confirmed via retrograde and antegrade urethrography.
  • Management involved initial suprapubic catheterization, followed by endoscopic realignment after a week of conservative care.

Main Results:

  • All patients achieved successful voiding after three months of clean intermittent self-catheterization (CISC).
  • Two of eight patients completing follow-up developed urethral stricture, managed with direct vision urethrotomy (DVU) and CISC.
  • One patient experienced erectile dysfunction, which improved with phosphodiesterase inhibitors; no patients had incontinence.

Conclusions:

  • Early endoscopic realignment is a minimally invasive and effective treatment for complete posterior urethral injuries.
  • This technique demonstrates low rates of post-operative incontinence and erectile dysfunction.
  • Endoscopic realignment offers a favorable outcome for managing traumatic posterior urethral injuries.