Pelvic Fracture Urethral Injuries: Evaluation of Various Methods of Management |
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Authors: | Mamdouh M Koraitim |
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Institution: | Department of Urology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. |
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Abstract: | PurposeThe results of various immediate treatments of urethral injuries complicating a fractured pelvis were evaluated.Materials and MethodsThe records of 100 male patients with pelvic fracture urethral injury were reviewed, 73 of whom were treated by suprapubic cystostomy and delayed repair, 23 by primary realignment and 4 by primary suturing. Also, the findings of 771 patients reported in the literature were reviewed.ResultsUrethral stricture was an almost inevitable consequence (97 percent of the cases) after suprapubic cystostomy. Primary realignment decreased the incidence of stricture to 53 percent but produced a 36 percent impotence rate. Primary suturing also decreased the incidence of stricture to 49 percent but produced the greatest complication rates for impotence (56 percent) and incontinence (21 percent).ConclusionsSuprapubic cystostomy alone is indicated for incomplete urethral rupture, slight urethral distraction and critically unstable patients, and when there are inadequate facilities or inexperienced surgeons. Primary realignment is advised if there is wide separation of the urethral ends, or associated injury of the bladder neck or rectum. Primary suturing is not recommended for any condition. |
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