EFFECTIVENESS OF TRANSPUBIC URETHROPLASTY FOR RECURRENT URETHRAL STRUCTURE IN PELVIC FRACTURE URETHRAL DISTRACTION DEFECT
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2015, Vol 2, Issue 33
Abstract
Effectiveness of Transpubic urethroplasty in recurrent (failed) urethral strictures due to pelvic fracture urethral distraction defects. INTRODUCTION: Urethral distraction injuries occur upto 10% of pelvic fracture cases. The principle indication of Transpubic urethroplasty is length >3cms, recurrent (failed) repairs of posterior urethral stricture. Though other procedures like primary anastomotic urethroplasty, rerouting of the urethra under the corporal body, urethral substitution with tubularised flaps, two stage urethroplasty are described, Transpubic urethroplasty is said to produce the best results especially when repeat procedures are required. MATERIALS & METHODS: This is a prospective study from 2004 to 2014 consisting of 17 patients having recurrent stricture urethra secondary to pelvic fracture urethral distraction defects (PFUDD). All the patients were males and their age ranged from 15year to 45 years. Pre-op evaluation included X-ray KUB, Ultrasound abdomen & pelvis, retrograde urethrogram (RGU), micturating cystourethrogram (MCU), up and down Cystoscopy, urine culture and renal biochemical parameters. Urethra was approched through progressive perineal and abdominal approach with total pubectomy, followed by excising fibrosed stricture and tension free end to end anastomosis. Post operatively pericatheteral RGU was carried out after 4 weeks and Catheter removed if there was no leak. RGU, MCU uroflowmetry and PVR were done one month after removal of catheter. Subsequently UFR, PVR and obstructive symptoms were assessed periodically. RESULTS: All 17 Cases were followed up for a period of 3-11 years. Out of 17patients, 14(80%) patients maintained good uroflow (UFR) and insignificant PVR and procedure was considered successful. In 3 patients procedure failed, of which 2 patients had pericatheter leak and reduced urinary flow with significant PVR and were followed up with CIC and 1 patient remained on permanent SPC. Overall stricture free rate was 80%. CONCLUSION: Transpubic urethroplasty appears to be superior substitute for recurrent stricture due to pelvic fracture urethral distraction defects (PFUDDs). Pericatheteral leak, fibrosis, fistulae seems to be an important factor in determining the successful outcome.
Authors and Affiliations
Mudegowdar Shivshankarappa, Rajesh Ranjan, Gururaj Padasalagi, Imdad Ali N, Vasanth Shet S.
STUDY OF UPPER GASTROINTESTINAL ENDOSCOPY FINDINGS AND PRESENCE OF HELICOBACTER PYLORI INFECTION AMONG ADULT PATIENTS OF UPPER ABDOMINAL PAIN AND DYSPEPSIA
BACKGROUND Dyspepsia is a common presenting complaint of various upper gastrointestinal disorders. The symptoms of causes of dyspepsia often overlap and this makes aetiological diagnosis difficult. Endoscopy is the ideal...
LAPAROSCOPIC SURGERY IN THE MANAGEMENT OF EARLY GASTRIC CANCER
INTRODUCTION This study was performed to check Laparoscopic Surgery in the management of early Gastric Cancer. For that we choose laparoscopic and laparoscopic Assisted Gastrectomies for 119 cases. It was performed durin...
NESTROFT AS A SCREENING TOOL TO IDENTIFY BETA THALASSAEMIA TRAIT IN PAEDIATRIC CASES
BACKGROUND Thalassemia is the most common genetic disorder worldwide. Indian Academy of Paediatrics has reported a frequency of thalassemia trait of 3-18% in Northern India and 1-3% or even less in the Southern part of I...
CLINICO-HAEMATOLOGICAL STUDY OF PANCYTOPENIA IN A TERTIARY CARE CENTRE
BACKGROUND Pancytopenia is one of the pathological manifestation resulting from various underlying disease processes affecting the bone marrow. Hence, bone marrow examination is the diagnostic tool to detect the underlyi...
THORACO-ABDOMINAL FLAP FOR RESURFACING LARGE POST MASTECTOMY DEFECTS IN LOCALLY ADVANCED CA. BREAST
Covering of large wounds after mastectomy in locally advanced Ca breast with skin that can withstand radiotherapy is a challenge to the surgeon. Here this study we used a local advancement flap from the adjacent area cal...