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Hinged transpubic approach to delayed repair of posterior urethral distraction defects complicating pelvic fractures — Preliminary experience

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Abstract

Objective

To present our experience with a transpubic approach to the management of one of the most challenging injuries of the lower urinary tract.

Patients and Methods

Between January 2003 and December 2005, 7 patients presenting to our unit with complex urethral distraction defects due to type 2 or 3 posterior urethral disruption injuries complicating pelvic fracture were included in an ongoing evaluation of the transpubic approach to the repair of such defects. The patients had a mean age of 37.7 (range 22–56) years and were followed up for 1–4 years.

Results

After the follow-up period 4 patients had a very successful outcome with trouble-free voiding. Three developed strictures, two of which were successfully managed with regular dilatation, while the third patient became catheter-dependent following dilatation and inadvertent creation of a false passage. This patient underwent a successful re-operation with full recovery.

Conclusion

The transpubic approach to delayed repair of urethral distraction defects complicating pelvic fracture is feasible. It allows an effective dissection of the dense hematoma-fibrosis that commonly complicates these injuries at a later stage. The approach is particularly useful in complex long-standing defects where such dissection is made relatively easy by the ample working space provided. The successful outcome of treatment by this approach in 4 and ultimately 5 out of 7 patients offers a reasonable degree of salvage for patients with an otherwise poor prognosis. Further studies are warranted to confirm our positive results.

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Authors and Affiliations

  1. Urology, Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Calabar, Calabar, Nigeria

    A. Essiet & P. D. Ekwere

  2. Orthopedic Units, Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Calabar, Calabar, Nigeria

    I. A. Ikpeme

  3. Urology Unit, Dept. of Surgery, College of Medicine, University of Calabar, Calabar, Nigeria

    A. Essiet

Authors
  1. A. Essiet
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  2. P. D. Ekwere
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  3. I. A. Ikpeme
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Correspondence to A. Essiet.

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Essiet, A., Ekwere, P.D. & Ikpeme, I.A. Hinged transpubic approach to delayed repair of posterior urethral distraction defects complicating pelvic fractures — Preliminary experience. Afr J Urol 14, 75–80 (2008). https://doi.org/10.1007/s12301-008-0008-x

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  • DOI: https://doi.org/10.1007/s12301-008-0008-x

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