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Delayed repair of post-traumatic posterior urethral distraction injuries: long-term results
Objectives. There is still controversy regarding the treatment of post-traumatic posterior urethral distraction injuries. Initial suprapubic cystostomy and delayed perineal urethral reconstruction has been considered the reference standard. In this report, we review our experience with delayed perin...
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Published in: | Urology (Ridgewood, N.J.) N.J.), 2000-06, Vol.55 (6), p.837-841 |
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description | Objectives. There is still controversy regarding the treatment of post-traumatic posterior urethral distraction injuries. Initial suprapubic cystostomy and delayed perineal urethral reconstruction has been considered the reference standard. In this report, we review our experience with delayed perineal urethral reconstruction, with a focus on the long-term outcome and complications.
Methods. A total of 77 men with posterior urethral distraction injury due to pelvic trauma underwent reconstruction with delayed perineal approach. In all cases, the area of fibrosis was aggressively excised, the corpus spongiosum was mobilized, and a tension-free, spatulated end-to-end anastomosis was achieved by splitting the corporeal bodies in 66.2% and by an additional perineally performed inferior pubectomy in 49.3% of the patients. The median time from injury to surgical repair was 12 months. The preoperative evaluation consisted of combined antegrade and retrograde cystourethrograms and cystourethrography. A detailed sexual history was obtained in 58 patients (75.3%).
Results. After a mean follow-up of 47 months (range 15 months to 14 years), the urethral continuity was adequate in 94.8%; however, 2 patients required a perineal surgical revision (total of 79 operations). Postoperative incontinence was observed in 7 (9.1%) of 77 patients. Postoperative erectile dysfunction was noted in 16.2% of patients who were known to be potent by history before surgery.
Conclusions. Our results support the belief that delayed perineal reconstruction with extensive excision of fibrosis and a tension-free, spatulated end-to-end anastomosis is a successful treatment alternative for posterior urethral distraction defects, with acceptable morbidity. |
doi_str_mv | 10.1016/S0090-4295(00)00464-7 |
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Methods. A total of 77 men with posterior urethral distraction injury due to pelvic trauma underwent reconstruction with delayed perineal approach. In all cases, the area of fibrosis was aggressively excised, the corpus spongiosum was mobilized, and a tension-free, spatulated end-to-end anastomosis was achieved by splitting the corporeal bodies in 66.2% and by an additional perineally performed inferior pubectomy in 49.3% of the patients. The median time from injury to surgical repair was 12 months. The preoperative evaluation consisted of combined antegrade and retrograde cystourethrograms and cystourethrography. A detailed sexual history was obtained in 58 patients (75.3%).
Results. After a mean follow-up of 47 months (range 15 months to 14 years), the urethral continuity was adequate in 94.8%; however, 2 patients required a perineal surgical revision (total of 79 operations). Postoperative incontinence was observed in 7 (9.1%) of 77 patients. Postoperative erectile dysfunction was noted in 16.2% of patients who were known to be potent by history before surgery.
Conclusions. Our results support the belief that delayed perineal reconstruction with extensive excision of fibrosis and a tension-free, spatulated end-to-end anastomosis is a successful treatment alternative for posterior urethral distraction defects, with acceptable morbidity.</description><identifier>ISSN: 0090-4295</identifier><identifier>EISSN: 1527-9995</identifier><identifier>DOI: 10.1016/S0090-4295(00)00464-7</identifier><identifier>PMID: 10840087</identifier><identifier>CODEN: URGYAZ</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Biological and medical sciences ; Child ; Fractures, Bone - complications ; Humans ; Male ; Medical sciences ; Middle Aged ; Pelvic Bones - injuries ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Time Factors ; Treatment Outcome ; Urethra - injuries ; Urethra - surgery</subject><ispartof>Urology (Ridgewood, N.J.), 2000-06, Vol.55 (6), p.837-841</ispartof><rights>2000 Elsevier Science Inc.</rights><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-d7d5f5a783c463a94d376e18fe1beedee2940a4b4e5ba1191fb0c41ee32436e33</citedby><cites>FETCH-LOGICAL-c390t-d7d5f5a783c463a94d376e18fe1beedee2940a4b4e5ba1191fb0c41ee32436e33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1406804$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10840087$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tunç, H.Murat</creatorcontrib><creatorcontrib>Tefekli, Ahmet H</creatorcontrib><creatorcontrib>Kaplancan, Tansel</creatorcontrib><creatorcontrib>Esen, Tarik</creatorcontrib><title>Delayed repair of post-traumatic posterior urethral distraction injuries: long-term results</title><title>Urology (Ridgewood, N.J.)</title><addtitle>Urology</addtitle><description>Objectives. There is still controversy regarding the treatment of post-traumatic posterior urethral distraction injuries. Initial suprapubic cystostomy and delayed perineal urethral reconstruction has been considered the reference standard. In this report, we review our experience with delayed perineal urethral reconstruction, with a focus on the long-term outcome and complications.
Methods. A total of 77 men with posterior urethral distraction injury due to pelvic trauma underwent reconstruction with delayed perineal approach. In all cases, the area of fibrosis was aggressively excised, the corpus spongiosum was mobilized, and a tension-free, spatulated end-to-end anastomosis was achieved by splitting the corporeal bodies in 66.2% and by an additional perineally performed inferior pubectomy in 49.3% of the patients. The median time from injury to surgical repair was 12 months. The preoperative evaluation consisted of combined antegrade and retrograde cystourethrograms and cystourethrography. A detailed sexual history was obtained in 58 patients (75.3%).
Results. After a mean follow-up of 47 months (range 15 months to 14 years), the urethral continuity was adequate in 94.8%; however, 2 patients required a perineal surgical revision (total of 79 operations). Postoperative incontinence was observed in 7 (9.1%) of 77 patients. Postoperative erectile dysfunction was noted in 16.2% of patients who were known to be potent by history before surgery.
Conclusions. Our results support the belief that delayed perineal reconstruction with extensive excision of fibrosis and a tension-free, spatulated end-to-end anastomosis is a successful treatment alternative for posterior urethral distraction defects, with acceptable morbidity.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Fractures, Bone - complications</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pelvic Bones - injuries</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Urethra - injuries</subject><subject>Urethra - surgery</subject><issn>0090-4295</issn><issn>1527-9995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><recordid>eNqFkE1P3DAQhq0KVBboTyjKoUL0EDpeO3bMBSHaAtJKPdCeerAce0KNknixHaT992Q_VLhxGo3meWdGDyGfKZxToOLbPYCCks9VdQbwFYALXsoPZEaruSyVUtUemf1HDshhSo8AIISQH8kBhZoD1HJG_n7HzqzQFRGXxscitMUypFzmaMbeZG83LUYfYjFGzP-i6Qrn0zS32Yeh8MPjGD2mi6ILw0M5of20K41dTsdkvzVdwk-7ekT-_Pzx-_q2XPy6ubu-WpSWKcilk65qKyNrZrlgRnHHpEBat0gbRIc4VxwMbzhWjaFU0bYByykim3MmkLEjcrrdu4zhacSUde-Txa4zA4YxaUmpYKqqJ7DagjaGlCK2ehl9b-JKU9Brq3pjVa-VaQC9sarllDvZHRibHt2b1FbjBHzZASZZ07XRDNanV46DqIFP2OUWw8nGs8eok_U4WHQ-os3aBf_OJy9me5WV</recordid><startdate>20000601</startdate><enddate>20000601</enddate><creator>Tunç, H.Murat</creator><creator>Tefekli, Ahmet H</creator><creator>Kaplancan, Tansel</creator><creator>Esen, Tarik</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20000601</creationdate><title>Delayed repair of post-traumatic posterior urethral distraction injuries: long-term results</title><author>Tunç, H.Murat ; Tefekli, Ahmet H ; Kaplancan, Tansel ; Esen, Tarik</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-d7d5f5a783c463a94d376e18fe1beedee2940a4b4e5ba1191fb0c41ee32436e33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Fractures, Bone - complications</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pelvic Bones - injuries</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Urethra - injuries</topic><topic>Urethra - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tunç, H.Murat</creatorcontrib><creatorcontrib>Tefekli, Ahmet H</creatorcontrib><creatorcontrib>Kaplancan, Tansel</creatorcontrib><creatorcontrib>Esen, Tarik</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urology (Ridgewood, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tunç, H.Murat</au><au>Tefekli, Ahmet H</au><au>Kaplancan, Tansel</au><au>Esen, Tarik</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delayed repair of post-traumatic posterior urethral distraction injuries: long-term results</atitle><jtitle>Urology (Ridgewood, N.J.)</jtitle><addtitle>Urology</addtitle><date>2000-06-01</date><risdate>2000</risdate><volume>55</volume><issue>6</issue><spage>837</spage><epage>841</epage><pages>837-841</pages><issn>0090-4295</issn><eissn>1527-9995</eissn><coden>URGYAZ</coden><abstract>Objectives. There is still controversy regarding the treatment of post-traumatic posterior urethral distraction injuries. Initial suprapubic cystostomy and delayed perineal urethral reconstruction has been considered the reference standard. In this report, we review our experience with delayed perineal urethral reconstruction, with a focus on the long-term outcome and complications.
Methods. A total of 77 men with posterior urethral distraction injury due to pelvic trauma underwent reconstruction with delayed perineal approach. In all cases, the area of fibrosis was aggressively excised, the corpus spongiosum was mobilized, and a tension-free, spatulated end-to-end anastomosis was achieved by splitting the corporeal bodies in 66.2% and by an additional perineally performed inferior pubectomy in 49.3% of the patients. The median time from injury to surgical repair was 12 months. The preoperative evaluation consisted of combined antegrade and retrograde cystourethrograms and cystourethrography. A detailed sexual history was obtained in 58 patients (75.3%).
Results. After a mean follow-up of 47 months (range 15 months to 14 years), the urethral continuity was adequate in 94.8%; however, 2 patients required a perineal surgical revision (total of 79 operations). Postoperative incontinence was observed in 7 (9.1%) of 77 patients. Postoperative erectile dysfunction was noted in 16.2% of patients who were known to be potent by history before surgery.
Conclusions. Our results support the belief that delayed perineal reconstruction with extensive excision of fibrosis and a tension-free, spatulated end-to-end anastomosis is a successful treatment alternative for posterior urethral distraction defects, with acceptable morbidity.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>10840087</pmid><doi>10.1016/S0090-4295(00)00464-7</doi><tpages>5</tpages></addata></record> |
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subjects | Adolescent Adult Biological and medical sciences Child Fractures, Bone - complications Humans Male Medical sciences Middle Aged Pelvic Bones - injuries Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Time Factors Treatment Outcome Urethra - injuries Urethra - surgery |
title | Delayed repair of post-traumatic posterior urethral distraction injuries: long-term results |
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