Paper Information

Title: 

PRIMARY REALIGNMENT OF POSTERIOR URETHRAL RUPTURE

Type: PAPER
Author(s): SALEHIPOUR M.*,ASKARI R.
 
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Name of Seminar: CONGREH ANJOMAN UROLOGY IRAN
Type of Seminar:  CONGRESS
Sponsor:  ANJOMAN OROLOGY
Date:  2005Volume 8
 
 
Abstract: 

TO INVERSTIGATE SUCCESS TATE, COMPIKCATIONS AND PROGNOSTIC VALUE OF PRIMARY REALIGNMENT OF URETHRA IN THE MANAGEMENT OF POSTERIOR URETHRAL RUPTURE.
REALIGNMENT OF URETHRA IN THE MANAGEMENT OF POSTERIOR URETHRAL RUPTRE.
MATERLALS AND METHODS: 15 MALE PATIENTS (12-75 YEARS OF AGE, MEAN=34) SUFFERED FROM TRAUMATIC POSTERIOR URETHRAL RUPTURE TYPE 2, 3 DOCUMENTED BY RETROGRADE URETHROGRAM (RUG) UNDERWENT PRIMARY REALIGNMENT OF URETHRA.
PROCEDURE: UNDER G/A, WE TRIED TO PASS AN INDWELLING FOLEY URETHROVESICALLY. THE TYPE OF THE FOLEY ATTACHED TO A NELATON CATHETER WHICH BROUGHT OUT OF THE BLADDER. ALSO WE PUT CYSTOSTOMY IN THE BLADDER SEPARATELY. 4 WEEKS AFTER OPERATION, THE FOLEY WAS CHANGED AND 8 WEEKS AFTER OPERATION THE HEALED URETHRA EVALUATED BY RUG WHILE THE INDWELLING FOLY WAS KEPT IN PLACE. AFTER DOCUMENTING THE PATENCY OF THE URETHRA, FOLEY WAS RERNOVED, CYSTOSTOMY CLAMPED AND IF THE PATIENT COULD VOID SATISFACTORILY, CYSTOSTMY WAS REMOVED AFTER 7-14 DAYS.
RESULTS: TILL THE OF THIS REPORT, OUT PATIENS FOLLOWED FOR 2-12 MONTHS. NONE OF THEM SUFFERED FROM INCONTINENCE POST- OPERATIVELY. 8 PATIENTS (53%) NEEDED AT LEAST ONE AUXILLARY PROCEDURE SUCH AS DIRECT OPTIC INTERNAL URTHOTOMY (DOIU) AND/OR URETHRAL DILATION (UD). 5 CASES (33%), 2 PATIENTS (133.3%) AND ONE CASE (6%) NEEDED ONE, 2 TIOMES AND 3 TIMES OF AUXILIARY PROCEDURE RESPECTIVELY.
DISCUSSION AND CONCLUSION: DESPITE OUR SHORT TERTN FOLLOW UP, IT SEEMS THAT PRIMARY REALIGMEMENT TECHNTQUE IS A SAFE PROCEDURE WITH LOW MORBIDITY IN THE MANAGEMENT OF POSTERIOR URETHRAL RUPTURE.
BY PERFORMING SUPRAUBIC URINARY DIVERSION AS THE ONLY PROCEDURE OF THE MANAGEMENT OF URETHRAL RUPTURE, THE RATE OF URETHRAL STRICTURE IS AS HIGH AS 96% THE STRICTURE WILL BE SEVERE ENOUGH THAT ALMOST ALWAYS SHOULD BE CORRECTED BY OPEN URETHROPLASTY. HOWEVER, AFTER PRIMARY REALIGNMENT THE RATE OF URETHRAL STRICTURE IS MUCH LOWER AND/OR UD.
SO DUE TO ITS LOW MORBIDITY, WE REVOMMCND THE PRIMARY REALIGNMENT AS THE PROCEDURE OF CHOOCE FOR MANAGEMENT OF POSTERIOR IRETHRAL RUPTURE. A ALTHOUGH PATIENTS WITH MULTIPLE TRAUMA AND COMPLEX PWLVIC FRACTURE, SHOULD BE EXCLUDED FROM THIS PROCEDURE.

 
Keyword(s): POSTERIOR URETHRAL RUPTURE, RETROGRADE URETHROGRAM (RUG) DIRECT OPTIC INTERNAL URTHROTOMY (DOTU) URETHRAL DILATION (UD)
 
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