Pelvic fracture urethral distraction defects: Early outcome of progressive perineal repair
Dr. Chethan JV, Dr. Rajendra B Nerli, Dr. Abhijith Musale, Dr. Shankar K, Shridhar Ghagane, Dr. Murigendra B Hiremath
Purpose: Controversy still exists regarding timing and approach for pelvic fracture urethral distraction defects. We review our experience with 1-stage 4-step progressive perineal approach for urethral reconstruction.
Materials and Methods: All patients presenting with urethral distraction injuries associated with pelvic fractures were initially assessed, stabilized and managed with suprapubic-catheter insertion. Progressive-perineal-urethral repair was performed at least 3-months following injury. Post-operative complications and early outcome was assessed in all these patients.
Results: During the study period Jan 2010-Jan 2014, 26 male patients with a mean age of 34 years presented with pelvic fracture and posterior urethral distraction defects. Progressive-perineal repair was performed at least 3 months later. The repair needed spongiosal mobilisation alone in 10 cases, additional corporal separation in 13 and inferior pubectomy in 3 cases. 2 patients failed to void following urethral catheter removal and developed recurrent strictures at the repair site. 24 patients voided well after catheter removal and are voiding adequately at a mean follow up of 31 months
Conclusion: Using the perineal approach and several manoeuvres, it is virtually possible to repair urethral distraction injuries through a perineal approach even with a long defect. Short term outcomes are good.