Assessment and Management of an Open Bladder Neck at Posterior Urethroplasty
| Autor: | Mamdouh M. Koraitim |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Urology Urethroplasty medicine.medical_treatment Radiography Urinary Bladder urologic and male genital diseases Preoperative care Fractures Bone Intraoperative Period Young Adult Cystography Urethra Risk Factors Preoperative Care medicine Humans Prospective Studies Child Pelvic Bones medicine.diagnostic_test Multiple Trauma business.industry Cystoscopy medicine.disease female genital diseases and pregnancy complications Surgery Neck of urinary bladder Concomitant Pelvic fracture Urologic Surgical Procedures business |
| Zdroj: | Urology. 76:476-479 |
| ISSN: | 0090-4295 |
| DOI: | 10.1016/j.urology.2009.11.043 |
| Popis: | Objectives To determine the factors that may influence the risk of injury to the bladder neck in patients sustaining a pelvic fracture urethral injury and report our experience in the management of an open bladder neck at the time of delayed repair. Methods We identified 21 patients with an open bladder neck on cystography before they underwent repair of a pelvic fracture urethral distraction defect. Of these patients, 12 were continent after urethroplasty and 9 received bladder neck reconstruction concomitant with or subsequent to urethroplasty. Bladder neck reconstruction was performed by Young-Dees-Leadbetter (5) or anterior bladder flap-tube (4) procedure. Results Patients with an incompetent bladder neck were usually (67%) children ≤15 years old, had been most commonly (75%) managed initially by primary realignment, and all (100%) had fracture of ipsilateral ischiopubic rami. The preoperative cystogram showed a bladder neck opening of a rectangular shape, and suprapubic cystoscopy revealed a fixedly open bladder neck. Of the 9 patients who received a bladder neck reconstruction, 7 (78%) had a successful outcome and 2 (22%) had a treatment failure. Conclusions It seems that the risk of injury to the bladder neck increases in children, in ipsilateral ischiopubic rami fracture and in cases managed initially by primary realignment. At posterior urethroplasty, the presence of an incompetent bladder neck is suspected by the finding of an open bladder neck of a rectangular shape on cystography and a fixedly open bladder neck on suprapubic cystoscopy. Reconstruction of the bladder neck by Young-Dees-Leadbetter procedure probably offers the best successful results. |
| Databáze: | OpenAIRE |
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