Delayed Posterior Urethroplasty Following Pelvic Fracture Urethral Injury: Do We Have to Wait 3 Months?

Kyle Scarberry, Jose Bonomo, Reynaldo G. Gómez

Resultado de la investigación: Article

5 Citas (Scopus)

Resumen

Objective: To compare outcomes with early vs delayed reconstruction following pelvic fracture urethral injury (PFUI) to determine if a traditional 3-month delay is necessary. This delay has been advocated to allow resolution of traumatic inflammation and hematoma but has never been validated. We proceed to reconstruction at 3-6 weeks if the associated injuries are stable, the perineum is soft on rectal palpation, and the fracture is stable for lithotomy positioning. Methods: PFUI patients treated with a suprapubic tube and delayed urethroplasty from October 1991 to August 2016 were included. Patients with initial catheter realignment were excluded. We compared reconstruction failure, incontinence, and erectile dysfunction rates in patients reconstructed within 6 weeks after injury with those reconstructed after the traditional ≥12 weeks. Results: Thirty-nine patients were identified with a median age of 32 years (17 to 69). Overall, the median urethral gap was 2 cm (1-4.5) and median follow-up was 64 months (12-277). Stricture failure occurrence was 5.1%, incontinence rate was 7.7%, and erectile dysfunction rate was 56.4%. The 22 patients with urethroplasty ≤6 weeks post-injury were no more likely to experience erectile dysfunction (13 vs 9, P =.70), urinary incontinence (1 vs 2, P =.40) or reconstruction failure (2 vs 0, P =.20) than the 17 patients delayed ≥12 weeks. Conclusion: We report similar outcomes following urethral reconstruction for PFUI patients repaired ≤6 weeks after injury compared with those delayed ≥12 weeks. This suggests that in selected cases reconstruction at 3-6 weeks is feasible, minimizing the morbidity of a suprapubic tube.

Idioma originalEnglish
Páginas (desde-hasta)193-197
Número de páginas5
PublicaciónUrology
Volumen116
DOI
EstadoPublished - 1 jun 2018
Publicado de forma externa

Huella dactilar

Wounds and Injuries
Erectile Dysfunction
Perineum
Digital Rectal Examination
Urinary Incontinence
Hematoma
Pathologic Constriction
Catheters
Inflammation
Morbidity

ASJC Scopus subject areas

  • Urology

Citar esto

Scarberry, Kyle ; Bonomo, Jose ; Gómez, Reynaldo G. / Delayed Posterior Urethroplasty Following Pelvic Fracture Urethral Injury : Do We Have to Wait 3 Months?. En: Urology. 2018 ; Vol. 116. pp. 193-197.
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title = "Delayed Posterior Urethroplasty Following Pelvic Fracture Urethral Injury: Do We Have to Wait 3 Months?",
abstract = "Objective: To compare outcomes with early vs delayed reconstruction following pelvic fracture urethral injury (PFUI) to determine if a traditional 3-month delay is necessary. This delay has been advocated to allow resolution of traumatic inflammation and hematoma but has never been validated. We proceed to reconstruction at 3-6 weeks if the associated injuries are stable, the perineum is soft on rectal palpation, and the fracture is stable for lithotomy positioning. Methods: PFUI patients treated with a suprapubic tube and delayed urethroplasty from October 1991 to August 2016 were included. Patients with initial catheter realignment were excluded. We compared reconstruction failure, incontinence, and erectile dysfunction rates in patients reconstructed within 6 weeks after injury with those reconstructed after the traditional ≥12 weeks. Results: Thirty-nine patients were identified with a median age of 32 years (17 to 69). Overall, the median urethral gap was 2 cm (1-4.5) and median follow-up was 64 months (12-277). Stricture failure occurrence was 5.1{\%}, incontinence rate was 7.7{\%}, and erectile dysfunction rate was 56.4{\%}. The 22 patients with urethroplasty ≤6 weeks post-injury were no more likely to experience erectile dysfunction (13 vs 9, P =.70), urinary incontinence (1 vs 2, P =.40) or reconstruction failure (2 vs 0, P =.20) than the 17 patients delayed ≥12 weeks. Conclusion: We report similar outcomes following urethral reconstruction for PFUI patients repaired ≤6 weeks after injury compared with those delayed ≥12 weeks. This suggests that in selected cases reconstruction at 3-6 weeks is feasible, minimizing the morbidity of a suprapubic tube.",
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Delayed Posterior Urethroplasty Following Pelvic Fracture Urethral Injury : Do We Have to Wait 3 Months? / Scarberry, Kyle; Bonomo, Jose; Gómez, Reynaldo G.

En: Urology, Vol. 116, 01.06.2018, p. 193-197.

Resultado de la investigación: Article

TY - JOUR

T1 - Delayed Posterior Urethroplasty Following Pelvic Fracture Urethral Injury

T2 - Do We Have to Wait 3 Months?

AU - Scarberry, Kyle

AU - Bonomo, Jose

AU - Gómez, Reynaldo G.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Objective: To compare outcomes with early vs delayed reconstruction following pelvic fracture urethral injury (PFUI) to determine if a traditional 3-month delay is necessary. This delay has been advocated to allow resolution of traumatic inflammation and hematoma but has never been validated. We proceed to reconstruction at 3-6 weeks if the associated injuries are stable, the perineum is soft on rectal palpation, and the fracture is stable for lithotomy positioning. Methods: PFUI patients treated with a suprapubic tube and delayed urethroplasty from October 1991 to August 2016 were included. Patients with initial catheter realignment were excluded. We compared reconstruction failure, incontinence, and erectile dysfunction rates in patients reconstructed within 6 weeks after injury with those reconstructed after the traditional ≥12 weeks. Results: Thirty-nine patients were identified with a median age of 32 years (17 to 69). Overall, the median urethral gap was 2 cm (1-4.5) and median follow-up was 64 months (12-277). Stricture failure occurrence was 5.1%, incontinence rate was 7.7%, and erectile dysfunction rate was 56.4%. The 22 patients with urethroplasty ≤6 weeks post-injury were no more likely to experience erectile dysfunction (13 vs 9, P =.70), urinary incontinence (1 vs 2, P =.40) or reconstruction failure (2 vs 0, P =.20) than the 17 patients delayed ≥12 weeks. Conclusion: We report similar outcomes following urethral reconstruction for PFUI patients repaired ≤6 weeks after injury compared with those delayed ≥12 weeks. This suggests that in selected cases reconstruction at 3-6 weeks is feasible, minimizing the morbidity of a suprapubic tube.

AB - Objective: To compare outcomes with early vs delayed reconstruction following pelvic fracture urethral injury (PFUI) to determine if a traditional 3-month delay is necessary. This delay has been advocated to allow resolution of traumatic inflammation and hematoma but has never been validated. We proceed to reconstruction at 3-6 weeks if the associated injuries are stable, the perineum is soft on rectal palpation, and the fracture is stable for lithotomy positioning. Methods: PFUI patients treated with a suprapubic tube and delayed urethroplasty from October 1991 to August 2016 were included. Patients with initial catheter realignment were excluded. We compared reconstruction failure, incontinence, and erectile dysfunction rates in patients reconstructed within 6 weeks after injury with those reconstructed after the traditional ≥12 weeks. Results: Thirty-nine patients were identified with a median age of 32 years (17 to 69). Overall, the median urethral gap was 2 cm (1-4.5) and median follow-up was 64 months (12-277). Stricture failure occurrence was 5.1%, incontinence rate was 7.7%, and erectile dysfunction rate was 56.4%. The 22 patients with urethroplasty ≤6 weeks post-injury were no more likely to experience erectile dysfunction (13 vs 9, P =.70), urinary incontinence (1 vs 2, P =.40) or reconstruction failure (2 vs 0, P =.20) than the 17 patients delayed ≥12 weeks. Conclusion: We report similar outcomes following urethral reconstruction for PFUI patients repaired ≤6 weeks after injury compared with those delayed ≥12 weeks. This suggests that in selected cases reconstruction at 3-6 weeks is feasible, minimizing the morbidity of a suprapubic tube.

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DO - 10.1016/j.urology.2018.01.018

M3 - Article

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EP - 197

JO - Urology

JF - Urology

SN - 0090-4295

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