Prospective Comparative Study Of Patients Outcome Amongst Different Sequential Steps Of Progressive Perineal Approach For Treatment Of Pelvic Fracture Urethral Injury
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Date
2024-09
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Publisher
Indian Society for Health and Advanced Research
Abstract
Introduction: Pelvic fractures, often from high-energy injuries, can cause pelvic fracture urethral injury (PFUI), especially in males. PFUI can lead to complications like urethral stenosis, erectile dysfunction, and urinary incontinence. These injuries usually occur with signi?cant trauma, such as vehicular accidents, and are indicated by blood at the meatus, inability to urinate, and a full bladder. Initial management involves suprapubic catheter placement, with delayed urethroplasty after 3-6 months being the gold standard treatment. This approach allows for local healing and successful tension-free anastomosis, reducing the risks of morbidity and complications. The study included 75 patientsMethodology: aged 18-61 with pelvic fracture urethral injuries. Excluded were those with in?ammatory, iatrogenic, congenital, recurrent, or post-radiation strictures. Patients underwent delayed urethroplasty with full bulbar urethra mobilization, end-to-end anastomosis, or additional procedures for tension. Postoperatively, patients had corrugated drains, and catheter removal was based on RUG ?ndings. Success was de?ned by effective voiding and no further interventions, while failure included persistent or recurrent strictures. Statistical analysis used chi-square tests. TheResult: studyl included 75 patients with pelvic fracture urethral injuries treated with progressive perineal urethroplasty. Procedures performed were urethral mobilization alone (52%), with corporal body separation (32%), and with inferior pubectomy (16%). The overall success rate was 88%, with urethral mobilization alone being the most successful (92.3%). Complications included erectile dysfunction (8%), re-stricture formation (16%), and wound infections (24%). Auxiliary procedures like Optical Internal Urethrotomy were effective for re-stricture management, highlighting the importance of tailored surgical approaches. Road traf?c accidents were the primary cause of pelvic fracture urethralConclusion: injuries. Perineal urethroplasty, the gold standard, shows excellent results. Key factors for success include maintaining urethral vascularity, meticulous scar tissue excision, and tension-free anastomosis. Achieving this may require distal urethral mobilization, crural separation, and occasionally inferior pubectomy. Recent approaches minimize steps, avoiding supracrural urethral rerouting. High-quality research is needed to improve diagnosis, management, and follow-up of urethral strictures.
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Keywords
Pelvic fracture urethral injury (PFUI), Urethral stenosis, Retrograde urethrography (RUG), Voiding cystourethrography (VCUG)
Citation
Gupta Mukesh, Mishra Shirish, Gupta Deepak Kumar, Chaurasia Dilip, Kumar Gaurav, Dahiya Mukul . Prospective Comparative Study Of Patients Outcome Amongst Different Sequential Steps Of Progressive Perineal Approach For Treatment Of Pelvic Fracture Urethral Injury . International Journal of Scientific Research. 2024 Sep; 13(9): 1-3