Early effectiveness of endoscopic posterior urethra primary alignment

Area of Science:

• Urology
• Trauma Surgery
• Pelvic Fracture Management

Background:

• Complete posterior urethral disruption is a complex surgical challenge following pelvic trauma.
• Posterior urethra primary realignment (PUPR) aims to reduce urethral gap, control bleeding, and enable urinary drainage.
• PUPR can facilitate concurrent orthopedic and trauma procedures without suprapubic catheterization.

Purpose of the Study:

• To assess the relationship between pelvic fracture severity and the success of endoscopic PUPR.
• To evaluate immediate PUPR in patients with complete posterior urethral disruption.
• To utilize the Young-Burgess classification system for categorizing pelvic fracture severity.

Main Methods:

• Retrospective review of a Level I trauma center database (January 2005 - April 2012).
• Inclusion of patients with pelvic fracture and complete posterior urethral disruption.
• Categorization of pelvic fracture severity using the Young-Burgess classification.
• Management included suprapubic catheterization followed by early urethral realignment in stable patients.
• Success defined by Foley catheterization; follow-up included radiologic, pressure studies, and cystoscopy.

Main Results:

• 18 patients (3.7%) diagnosed with complete posterior urethral disruption out of 481 pelvic trauma patients.
• 15 primary realignments (83.3%) performed within 5 days of trauma.
• 100% success rate for early realignment.
• No correlation found between pelvic ring fracture type and PUPR success.
• Postoperative complications included urethral strictures (53.3%), incontinence (20.0%), and erectile dysfunction (46.7%).
• Mean follow-up duration was 31.8 months.

Conclusions:

• Endoscopic PUPR is an effective treatment for complete posterior urethral disruption.
• PUPR facilitates urinary drainage for multispecialty surgical teams.
• The success of primary realignment is independent of pelvic fracture complexity or type.