Korean J Urol.  2006 Dec;47(12):1361-1366. 10.4111/kju.2006.47.12.1361.

Endoscopic Primary Realignment under Open Cystostomy in the Patients with Posterior Urethral Rupture that were Impossible for Lithotomy Position, Accompanied by Pelvic Bone Fracture : Long-term Results

• Lim JR
• Chung H
• Lee JB

• KMID: 2139784
• DOI: http://doi.org/10.4111/kju.2006.47.12.1361

Abstract

PURPOSE
The aim of this study was to evaluate the long-term results of endoscopic primary realignment of a posterior urethral rupture accompanied by a pelvic bone fracture.
MATERIALS AND METHODS
Our study population consists of 7 patients who were able to be followed up for at least 5 years, of an initial 8 that underwent endoscopic primary realignment of a posterior urethral rupture due to a pelvic bone fracture. Operations were carried out in the following order; the bladder was incised to allow a metal sound, with stitching fiber then tied at its end so it could be advanced into the injured proximal urethra through the bladder neck. The fiber was then traced using a cystoscope and connected to a urethral catheter, which could be indwelled in the bladder by pulling the sound back.
RESULTS
The mean follow-up period was 8.1 (5.2-9.7) years. The mean operation time was 48.3 (28-71) minutes. There were no severe disruptions of the pelvic hematoma, transfusions or other additive injuries during the operations. Post-operation complications were observed in 4 patients; 3 cases of mild urethral stricture, which were treated with an endoscopic intra-urethrotomy followed by clean intermittent catheterization, 3 cases of erectile dysfunction and 1 case each of urinary incontinence and a urethral stone.
CONCLUSIONS
This study clearly implies that endoscopic primary realignment of a severe posterior urethral rupture accompanied by a pelvic bone fracture is less invasive and a safer method, without pelvic hemorrhage or additional injuries. Early endoscopic intervention also improves the quality of life by reducing the possibility of an invasive procedure, and also prevents severe urethral stricture and the resultant complications by maintaining the continuity of the urethra.

Keyword

Urethra; Injury; Surgery

MeSH Terms

Cystoscopes
Cystostomy*
Erectile Dysfunction
Follow-Up Studies
Hematoma
Hemorrhage
Humans
Intermittent Urethral Catheterization
Male
Neck
Pelvic Bones*
Quality of Life
Rupture*
Urethra
Urethral Stricture
Urinary Bladder
Urinary Catheters
Urinary Incontinence

Figure

• 

  Fig. 1 Schematic illustration of the operative method. Metal sound, obtained with a Nelaton catheter anchored to 5.0 silk, passing into the bladder by way of the cystostomy site. The Nelaton catheter is grasped using foreign body forceps and pulled out through the urethra to reestablish the urethral continuity.

• 

  Fig. 2 A 26 year-old man with a posterior urethral rupture. (A) Retrograde urethrogram demonstrating a complete posterior urethral rupture and extravasation of contrast media at the ruptured urethra. (B) Retrograde urethrogram 6 weeks after a primary endoscopic urethral realignment.

• 

  Fig. 3 An 18 year-old man with a posterior urethral rupture. (A) Cystography showing a high-riding bladder. (B) Retrograde urethrogram 3 years after a primary endoscopic urethral realignment illustrating a diffuse stricture of the posterior urethra.

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