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Updated: May 22, 2025
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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
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Bulbar urethral necrosis: current concept and novel comprehensive classification.
Pankaj Joshi1, Jimena Navarro1, Maria Antonia Ocampo1
1Department of Reconstructive Urology, Urokul UroSurgery Institute, Pune, India.
BJU International
|March 17, 2025
Summary
Bulbar urethral necrosis (BUN), a complication of pelvic fracture urethral injury, is primarily vascular. A new radiological classification aids in predicting surgical difficulty for urethroplasty.
Area of Science:
- Urology
- Radiology
- Vascular Surgery
Background:
- Bulbar urethral necrosis (BUN) is a severe complication of pelvic fracture urethral injury (PFUI).
- It is directly linked to vascular damage and often arises after PFUI repairs.
- Understanding its pathophysiology and radiological features is crucial for effective management.
Purpose of the Study:
- To elucidate the pathophysiology of bulbar urethral necrosis (BUN).
- To propose a novel radiological classification for BUN.
- To correlate radiological findings with surgical outcomes.
Main Methods:
- Retrospective analysis of 145 patients with BUN treated between 1995 and 2023.
- Review of retrograde urethrograms to identify radiological patterns.
- Development of a four-type radiological classification system for BUN.
Main Results:
- BUN occurred in 10.8% of PFUI cases and 40.3% of complex PFUI.
- Two key radiological patterns were identified: penile-bulbar urethra relation and distal stump positioning.
- The proposed classification identified four types of BUN, with Type 3 (complete bulbar urethra loss) being the most common (35%).
Conclusions:
- Bulbar urethral necrosis is characterized by urethral segment absence, primarily due to vascular compromise.
- The novel radiological classification system effectively categorizes BUN.
- This classification is clinically important for predicting the difficulty of subsequent substitution urethroplasty.
