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Surgical Reconstruction of Pelvic Fracture Urethral Injury

  • Sanjay B. Kulkarni
  • Pankaj Joshi
  • Erick A. Ramírez Pérez
Chapter

Abstract

Posterior Urethral injuries after Pelvic Fracture are one of the most devastating and debilitating situations in Urology. It represents a real surgical and decision-making challenge. The adequate initial and late management to this problem with a multidisciplinary approach could avoid many possible urosexual and orthopedic complications, offering the best results to these patients.

Keywords

Pelvic fracture PFUI PFUDD Posterior urethral strictures 

Bibliography

  1. 1.
    Latini JM, McAninch JW, Brandes SB, Chung JY, Rosenstein D. SIU/ICUD consultation on urethral strictures: epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology. 2014;83(Suppl 3):S1–7.CrossRefGoogle Scholar
  2. 2.
    Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 2002;195:1–10.CrossRefGoogle Scholar
  3. 3.
    Palmer JK, Benson GS, Corriere JN Jr. Diagnosis and initial management of urological injuries associated with 200 consecutive pelvic fractures. J Urol. 1983;130:712.CrossRefGoogle Scholar
  4. 4.
    Fallon B, Wendt JC, Hawtrey CE. Urological injury and assessment in patients with fractured pelvis. J Urol. 1984;131:712.CrossRefGoogle Scholar
  5. 5.
    Kulkarni SB, Barbagli G, Kulkarni JS, Romano G, Lazzeri M. J Urol. 2010;183:1049–54.CrossRefGoogle Scholar
  6. 6.
    Tausch TJ, Calvalcanti AG, Soderdahl DW, Favorito L, Rabelo P, Morey AF. Gunshot wound injuries of the prostate and posterior urethra: reconstructive armamentarium. J Urol. 2007;178:1346–8.CrossRefGoogle Scholar
  7. 7.
    Rosenberg S, Joshi P, Laerence A, Surana S, Alhajeri F, Kulkarni SB. Management of female urethral trauma. J Urol. 2014;191(suppl 4):129.Google Scholar
  8. 8.
    Clark SS, Prudencio RF. Lower urinary tract injuries associated with pelvic fractures. Surg Clin North Am. 1972;52:183–20.CrossRefGoogle Scholar
  9. 9.
    Mouraviev VB, Santucci RA. Cadaveric anatomy of pelvic fracture urethral distraction injury: most injuries are distal to the external urinary sphincter. J Urol. 2005;173:86 9.CrossRefGoogle Scholar
  10. 10.
    Andrich DE, Mundy AR. The nature of urethral injury in cases of pelvic fracture urethral trauma. J Urol. 2001;165:1492–5.CrossRefGoogle Scholar
  11. 11.
    Whitson JM, Mc Aninch JW, Tanagho EA, Metro JM, Rahman NU. Mechanism of continence after repair of posterior urethral disruption: evidence of rhabdosphincter activity. J Urol. 2008;179:1035–9.CrossRefGoogle Scholar
  12. 12.
    Mundy AR. The role of delayed primary repair in the acute management of pelvic fracture injuries of the urethra. Br J Urol. 1991;68(3):273–6.CrossRefGoogle Scholar
  13. 13.
    Morey AF, McAninch JW. Reconstruction of posterior urethral disruption injuries: outcome analysis in 82 patients. J Urol. 1997;157:506–10.CrossRefGoogle Scholar
  14. 14.
    Kricun ME. Fractures of the pelvis. Orthop Clin North Am. 1990;21:573.PubMedGoogle Scholar
  15. 15.
    Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop Res. 1980;151:12.Google Scholar
  16. 16.
    Andrich DE, Day AC, Mundy AR. Proposed mechanism of lower urinary tract injury in fractures of the pelvic ring. BJU Int. 2007;100:567–73.CrossRefGoogle Scholar
  17. 17.
    Zou Q, Zhou S, Zhang K, Yang R, Fu Q. The immediate management of pelvic fracture urethral injury-endoscopic realignment or cystostomy? J Urol. 2017;198:869–74.CrossRefGoogle Scholar
  18. 18.
    Montgomery B, Husmann D. Pelvic fracture urethral distraction defect (PFUDD) with associated rectal injury: review of acute and definitive urologic management with long term outcomes. PD44-07. J Urol. 195(45 Suppl):e1000.Google Scholar
  19. 19.
    Iselin CE, Webster GD. The significance of the open bladder neck associated with pelvic fracture urethral distraction defects. J Urol. 1999;162:347–51.CrossRefGoogle Scholar
  20. 20.
    Mundy AR, Andrich DE. Pelvic fracture-related injuries of the bladder neck and prostate: their nature, cause and management. BJU Int. 2009;105:1302–8.CrossRefGoogle Scholar
  21. 21.
    Koraitim MM. Pelvic fracture urethral injuries: the unresolved controversy. J Urol. 1999;161:1433–41.CrossRefGoogle Scholar
  22. 22.
    Colapinto V, MacCallum RM. Injury to the male posterior urethra in fractured pelvis, a new classification. J Urol. 1977;18:575.CrossRefGoogle Scholar
  23. 23.
    Goldman SM, Sandler CM, Corriere JN, McGuire EJ. Blunt urethral trauma a unified, anatomical mechanical classification. J Urol. 1997;157:85–9.CrossRefGoogle Scholar
  24. 24.
    Koraitim MM. Gapometry and anterior urethrometry in the repair of posterior urethral defects. J Urol. 2008;179:1879–19.CrossRefGoogle Scholar
  25. 25.
    Gomez RG, Mundy T, Dubey D, El-Kassaby AW, Firdaoessaleh Kodama R, et al. SIU/ICUD consultation on urethral strictures: pelvic fracture urethral injuries. Urology. 2014;83(3):S48–58.CrossRefGoogle Scholar
  26. 26.
    MacDiarmid S, Rosario D, Chapple CR. The importance of accurate assessment and conservative management of the open bladder neck in patients with pelvic fracture membranous urethral distraction defects. Br J Urol. 1995;75:65–7.CrossRefGoogle Scholar
  27. 27.
    Osman NI, Mangera A, Inman RD, Chapple CR. Delayed repair of pelvic fracture urethral injuries: preoperative decision-making. Arab J Urol. 2015;13:217–20.CrossRefGoogle Scholar
  28. 28.
    Shenfeld OZ, Kisekgorf D, Gofrit ON, Verstanding AG, Landau EH, Pode D. The incidence and causes of erectile dysfunction after pelvic fractures associated with posterior urethral disruption. J Urol. 2003;169:2173–6.CrossRefGoogle Scholar
  29. 29.
    Fu Q, Sun X, Tang C, Cui R, Chen L. J Sex Med. 2012;9:282–7.CrossRefGoogle Scholar
  30. 30.
    Koraitim MM. Predictors of erectile dysfunction post pelvic fracture urethral injuries: a multivariate analysis. Urology. 2013;81:1081–5.CrossRefGoogle Scholar
  31. 31.
    Zukerman J, Mc Cammon K, Tisdale B, Colen T, Urosjie T, McAdams P, Jordan G. Urology. 2012;80(6):1369–74.CrossRefGoogle Scholar
  32. 32.
    Ali M, Safriel Y, Sclafani SJ, Schulza R. CT signs of urethral injury. Radiographics. 2003;23:951–63.CrossRefGoogle Scholar
  33. 33.
    Joshi P, Desai D, Surana S, Orabi H, Kulkarni SB. PD 29-11 Magnetic Resonance Imaging (MRI) in pelvic fracture imaging injuries to evaluate urethral gap: a new point of technique. 2017;197(4 suppl):e 576–7.Google Scholar
  34. 34.
    Hosseini SJ, Kaviani A, Jabbari M, Hosseini MM, Haji-Mohammadmehdi-Arab A, Simaei NR. Diagnostic application of flexible cystoscope in pelvic fracture urethral distraction defects. J Urol. 2006;3:204–7.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Sanjay B. Kulkarni
    • 1
  • Pankaj Joshi
    • 1
  • Erick A. Ramírez Pérez
    • 2
  1. 1.Kulkarni Reconstructive Urology CenterPuneIndia
  2. 2.Centro de UretraMexico CityMexico

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