Multicenter analysis of posterior urethroplasty complexity and outcomes following pelvic fracture urethral injury.

Autor: Johnsen NV; Departments of Urology, University of Washington, Seattle, WA, USA. nielsvj@uw.edu.; Harborview Medical Center, Box 359868, 325 Ninth Ave, Seattle, WA, 98104, USA. nielsvj@uw.edu., Moses RA; University of Utah, Salk Lake City, UT, USA., Elliott SP; University of Minnesota, Minneapolis, MN, USA., Vanni AJ; Lahey Hospital and Medical Center, Burlington, MA, USA., Baradaran N; University of California San Francisco, San Francisco, CA, USA., Greear G; University of California, San Diego, USA., Smith TG 3rd; Baylor College of Medicine, Houston, TX, USA., Granieri MA; New York University, New York, NY, USA., Alsikafi NF; Uropartners, Gurnee, IL, USA., Erickson BA; University of Iowa (BAE), Iowa City, IA, USA., Myers JB; University of Utah, Salk Lake City, UT, USA., Breyer BN; University of California San Francisco, San Francisco, CA, USA., Buckley JC; University of California, San Diego, USA., Zhao LC; New York University, New York, NY, USA., Voelzke BB; Departments of Urology, University of Washington, Seattle, WA, USA.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2020 Apr; Vol. 38 (4), pp. 1073-1079. Date of Electronic Publication: 2019 May 29.
DOI: 10.1007/s00345-019-02824-5
Abstrakt: Purpose: To analyze outcomes of posterior urethroplasty following pelvic fracture urethral injuries (PFUI) and to determine risk factors for surgical complexity and success.
Methods: Patients who underwent posterior urethroplasty following PFUI were identified in the Trauma and Urologic Reconstructive Network of Surgeons (TURNS) database. Demographics, injury patterns, management strategies, and prior interventions were evaluated. Risk factors for surgical failure and the impact of ancillary urethral lengthening maneuvers (corporal splitting, pubectomy and supracrural rerouting) were evaluated.
Results: Of the 436 posterior urethroplasties identified, 122 were following PFUI. 83 (68%) patients were acutely managed with suprapubic tubes, while 39 (32%) underwent early endoscopic realignment. 16 (13%) patients underwent pelvic artery embolization in the acute setting. 116 cases (95%) were completed via a perineal approach, while 6 (5%) were performed via an abdominoperineal approach. The need for one or more ancillary maneuvers to gain urethral length occurred in 4 (36%) patients. Of these, 44 (36%) received corporal splitting, 16 (13%) partial or complete pubectomy, and 2 (2%) supracrural rerouting. Younger patients, those with longer distraction defects, and those with a history of angioembolization were more likely to require ancillary maneuvers. 111 patients (91%) did not require repeat intervention during follow-up. Angioembolization (p = 0.03) and longer distraction defects (p = 0.01) were associated with failure.
Conclusions: Posterior urethroplasty provides excellent success rates for patients following PFUI. Pelvic angioembolization and increased defect length are associated with increased surgical complexity and risk of failure. Surgeons should be prepared to implement ancillary maneuvers when indicated to achieve a tension-free anastomosis.
Databáze: MEDLINE
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