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Urethral Distraction Injuries(Due to Pelvic Fracture)

Posterior pelvic fracture urethral distraction defect (PFUDD) is a challenging urologic problem that may result in complications, such as urinary incontinence and inability to void due to recurrent stricture leading to a lifelong disabling condition.

The most common etiology of posterior urethral injury is motor vehicle accidents.

Modern cross-sectional imaging, such as sonourethrography and magnetic resonance imaging help assess stricture pathology better, but their precise role in PFUDD management remains undefined. In regular case assessment can be done by combined retrograde urethrogram (RGU) + micturatingcystourethrogram (MCU) or by doing bougie + RGU.

As the understanding of the disease process has improved with evolution of better imaging in the form of magnetic resonance imaging (MRI) and Doppler ultrasound and with better surgical techniques, the success rates of posterior anastomotic urethroplasty have improved worldwide.

The most important complication of surgical reconstruction is restenosis, occurring in less than 10% cases, most of which can be corrected by a redo anastomotic urethroplasty. The most common complication associated with this condition is erectile dysfunction. Urinary incontinence is a much rarer complication of this surgery in the present day.

SURGICAL CONSIDERATIONS

The principles in the surgical management of posterior urethral distraction defect include complete excision of scar tissue involving the membranoprostatic region, lateral fixation of pliable prostatic mucosa, and creation of a tension-free mucosa to mucosa anastomosis. This can be accomplished by progressive perineal approach in most cases, with abdomino-perineal approach being required only in a few select patients. The most important maneuver to achieve tension-free anastomosis is the mobilization of bulbar urethra, which is sufficient in many cases to bridge a gap of 2–3 cm. An elaborated perineal approach including separation of corporal bodies, inferior pubectomy, and supracrural rerouting of the urethra or a perineoabdominal approach with superior or total pubectomy is required in longer defects or complex cases .The purpose of these techniques is to straighten the normally curved course of the urethra and to achieve a shorter distance to the prostatic urethra.

WHY CHOOSE DR GAUTAM BANGA: Pelvic fracture associated urethral injuries are complex injuries and requires surgical intervention by expert urethral reconstructive surgeon. Dr.Gautam is one of the finest reconstructive urologists with experience of more than 800 Urethroplasties and has delivered success rate of more than 90%.

POST OPERATIVE INSTRUCTIONS:

You have had an operation to repair a narrow place in your urethra called a urethral stricture. Following these guidelines will help you heal faster and feel better at home.

Beginning the day you return home, you may climb stairs and move about your home for meals, to go to the bathroom or to watch television. The most important thing one can do to minimize swelling and post-operative discomfort is to avoid standing except for brief periods for the first 5 post-operative days. This is to maximize the success of graft “take” and minimize the possibility that further surgical procedures will be needed in the future. A padded ice bag applied to the surgical area may be helpful for the first 24 hours. After that it usually provides little benefit. After 5 days, one can slowly increase activity as long as the post-operative discomfort is decreasing. Remember, even though we place local anaesthetic during surgery and pain medications are prescribed for the post-operative period, post-operative pain is normal. Swelling and bruising are normal following this procedure and resolve without intervention in about 2 weeks. Incisions in the area under the scrotum are unique in that they often produce a sensation of strange numbness. That is normal and will resolve spontaneously over a few months.

Your incision is covered by either Dermabond glue or Steri-Strip tapes. They support the skin closure, but be assured that an absorbable suture line just under the skin is actually holding the incision together. Dermabond glue or Steri-Strips usually peel off spontaneously after two weeks.

You may shower beginning the second day you are home, but do not take tub baths for three weeks. Pat dry your surgical incision after you shower. The Steri-Strip tapes across your incision should remain on for at least one week. They support the skin closure, but, be assured that an absorbable suture line just under the skin is actually holding the incision together. Steri-Strips usually come off spontaneously after two weeks. If you do not have Steri-Strips it means that Dermabond glue was used as the surgical dressing. This will come off spontaneously without intervention.

Do not begin purposeful exercise until after the catheter is removed 3 weeks after surgery. Urethral catheters must remain in for 3 full weeks after urethroplasty! Some people may require as much as two additional weeks even though they are having a “normal” post-operative recovery. Your urine may periodically turn pink or bloody. This is normal, and will resolve once the catheter is removed.

Many urethral stricture repairs require the harvest of tissue from the inside of the mouth for use as a donor graft. This area can be kept clean by normal oral hygiene. The site acts like a very large canker sore. Most discomfort usually resolves in one week and is near normal in three weeks. Occasionally there is spotty lip numbness that usually resolves spontaneously. Most people avoid sour food and drink while the donor site is healing. This site almost never becomes infected.

Activities :

  • After the first week you may drive, but not while taking pain medicine.
  • You may shower. Do not take tub baths until the catheter is removed.
  • You may eat the foods you normally eat.
  • Minimize walking until the catheter is removed, but especially during the first 5 days.
  • Be sure to take the antibiotic that was prescribed.

Call the urologic surgical practice 24/7 at (9999062316) if you have….

  • Fever over 101ºF
  • Large blood clots in your urine that cause the catheter not to drain well
  • A catheter that stops draining

RESULTS:

Most patients have a good outcome when they are treated for a urethral stricture.

Our technical success rate for primary cases exceeds 90%.

Results of Re-do and complex urethral injuries are around 80%.

“Most important factor for good success rate is formal training in urethral surgery”- says Dr Banga

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