International Journal of Medical and Health Research

International Journal of Medical and Health Research


International Journal of Medical and Health Research
International Journal of Medical and Health Research
Vol. 2, Issue 3 (2016)

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.
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