Is Primary Realignment Appropriate for the Initial Management of Straddle Injuries to the Bulbar Urethra?

Autor: Ojima K; Department of Urology, National Defense Medical College, Saitama, Japan., Horiguchi A; Department of Urology, National Defense Medical College, Saitama, Japan. Electronic address: impreza@ndmc.ac.jp., Shinchi M; Department of Urology, National Defense Medical College, Saitama, Japan., Masunaga A; Department of Urology, National Defense Medical College, Saitama, Japan., Kimura F; Department of Urology, Nishisaitama-chuo National Hospital, Saitama, Japan., Takahashi E; Department of Urology, Nishisaitama-chuo National Hospital, Saitama, Japan., Asano T; Department of Urology, National Defense Medical College, Saitama, Japan., Ito K; Department of Urology, National Defense Medical College, Saitama, Japan., Azuma R; Department of Plastic Surgery, National Defense Medical College, Saitama, Japan.
Jazyk: angličtina
Zdroj: Urology [Urology] 2020 Feb; Vol. 136, pp. 251-256. Date of Electronic Publication: 2019 Nov 14.
DOI: 10.1016/j.urology.2019.09.050
Abstrakt: Objective: To compare the clinical courses of patients with straddle injuries to the bulbar urethra based on the initial management strategy for urinary drainage, mainly suprapubic tube placement (SPT) and primary realignment (PR), and to examine whether PR has a beneficial effect on subsequent urethroplasty with regards to surgical and patient-reported outcomes.
Methods: We reviewed the clinical courses of 126 patients with bulbar urethral stricture following straddle injuries who underwent delayed urethroplasty between August 2010 and April 2019. Patients were categorized as being initially treated with SPT (82 patients) or PR (44 patients). Stricture was considered complicated if preoperative urethrography or cystoscopy revealed iatrogenic scarring or a stricture away from the injury site.
Results: The percentage of patients who experienced delayed transurethral treatment at least once before referral was significantly higher in patients treated with PR than in those treated with SPT (25/44, 56.8% vs 16/82, 19.8%, P < .0001). Although there was no difference in stricture length in both cohorts, the fraction of patients with complicated stricture was significantly higher in patients treated with PR than in those treated with SPT (15/44, 34.1% vs 14/82, 17.1%, P = .003). There was no significant difference in the selected type of urethroplasty, operative time, blood loss, success rate, postoperative maximum urinary flow rate, voiding symptoms, or erectile function between the 2 groups.
Conclusion: PR does not facilitate delayed urethroplasty and had no beneficial effect on urethroplasty outcome. PR might lead to delayed transurethral procedures, resulting in increased risk of complicated strictures.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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