Nontransecting anastomotic urethroplasty of pelvic fracture urethral injury: A demonstration of technique
Background: Nontransecting urethroplasty for pelvic fracture urethral injuries (PFUI) has been shown to have equivalent patency rates to the transecting anastomotic urethroplasty while resulting in a decreased de novo erectile dysfunction rate [1–4]. A barrier to more widespread adoption of the non-...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-12-01
|
| Series: | Urology Video Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590089720300360 |
| _version_ | 1819070516128907264 |
|---|---|
| author | Min Suk Jun Peggy Gluszak Lee C. Zhao |
| author_facet | Min Suk Jun Peggy Gluszak Lee C. Zhao |
| author_sort | Min Suk Jun |
| collection | DOAJ |
| description | Background: Nontransecting urethroplasty for pelvic fracture urethral injuries (PFUI) has been shown to have equivalent patency rates to the transecting anastomotic urethroplasty while resulting in a decreased de novo erectile dysfunction rate [1–4]. A barrier to more widespread adoption of the non-transecting technique is the perception that exposure and placement of the proximal anastomotic sutures is difficult, and that specialized instruments or retractors are necessary. Herein, we share our technique to demonstrate how to perform non-transecting anastomotic urethroplasty for PFUI with minimal specialized equipment and a training method for practicing the placement of the proximal anastomotic sutures. Materials and methods: The nontransecting urethroplasty is performed on a 31-year-old male who suffered PFUI with a subsequent urethral obliteration at the level of the membranous urethra. The patient is placed in regular lithotomy, and a Lone Star (Cooper Surgical, Trumbull, CT) retractor with a vaginal pack tied to the head of the bed is used for exposure. Dissection is carried to the point of complete obliteration. Scar tissue is fully excised from both ends of the urethra while preserving the ventral spongiosum and bulbar arteries. Ten to 12 proximal anastomotic sutures are placed from outside to inside the lumen by employing the ski needle technique. We demonstrate a simple practice model built from common items to practice this versatile technique. The right sided sutures are then passed from inside to outside on the distal urethral end. A urethral catheter is placed followed by the remaining sutures. The central tendon is cut to increase urethral mobilization. The sutures are then tied down while the assistant provides cephalad traction of the bulbar urethra. Results: The Foley catheter was removed after two weeks and the suprapubic tube was clamped. The suprapubic tube was removed one week later after demonstrating a post void residual of zero ml. The patient is completely continent and has excellent erectile function. Conclusion: Nontransecting anastomotic urethroplasty is an excellent technique for treating PFUI while minimizing well-known complications of traditional excision and primary anastomotic posterior urethroplasty such as de novo erectile dysfunction. Proximal urethral suturing is a challenging aspect of posterior urethroplasty but can be mastered through practice on a suturing model. |
| first_indexed | 2024-12-21T17:07:10Z |
| format | Article |
| id | doaj.art-18961929cef4417d9a07b1f491ed1057 |
| institution | Directory Open Access Journal |
| issn | 2590-0897 |
| language | English |
| last_indexed | 2024-12-21T17:07:10Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Urology Video Journal |
| spelling | doaj.art-18961929cef4417d9a07b1f491ed10572022-12-21T18:56:29ZengElsevierUrology Video Journal2590-08972020-12-018100061Nontransecting anastomotic urethroplasty of pelvic fracture urethral injury: A demonstration of techniqueMin Suk Jun0Peggy Gluszak1Lee C. Zhao2NYU Langone Health Department of Urology, 222 E 41st Street 11th Floor, New York, NY, 10017, USANYU Department of Surgery New Bellevue, 15 North 1 550 First Avenue, New York, NY, 10016, USANYU Langone Health Department of Urology, 222 E 41st Street 11th Floor, New York, NY, 10017, USABackground: Nontransecting urethroplasty for pelvic fracture urethral injuries (PFUI) has been shown to have equivalent patency rates to the transecting anastomotic urethroplasty while resulting in a decreased de novo erectile dysfunction rate [1–4]. A barrier to more widespread adoption of the non-transecting technique is the perception that exposure and placement of the proximal anastomotic sutures is difficult, and that specialized instruments or retractors are necessary. Herein, we share our technique to demonstrate how to perform non-transecting anastomotic urethroplasty for PFUI with minimal specialized equipment and a training method for practicing the placement of the proximal anastomotic sutures. Materials and methods: The nontransecting urethroplasty is performed on a 31-year-old male who suffered PFUI with a subsequent urethral obliteration at the level of the membranous urethra. The patient is placed in regular lithotomy, and a Lone Star (Cooper Surgical, Trumbull, CT) retractor with a vaginal pack tied to the head of the bed is used for exposure. Dissection is carried to the point of complete obliteration. Scar tissue is fully excised from both ends of the urethra while preserving the ventral spongiosum and bulbar arteries. Ten to 12 proximal anastomotic sutures are placed from outside to inside the lumen by employing the ski needle technique. We demonstrate a simple practice model built from common items to practice this versatile technique. The right sided sutures are then passed from inside to outside on the distal urethral end. A urethral catheter is placed followed by the remaining sutures. The central tendon is cut to increase urethral mobilization. The sutures are then tied down while the assistant provides cephalad traction of the bulbar urethra. Results: The Foley catheter was removed after two weeks and the suprapubic tube was clamped. The suprapubic tube was removed one week later after demonstrating a post void residual of zero ml. The patient is completely continent and has excellent erectile function. Conclusion: Nontransecting anastomotic urethroplasty is an excellent technique for treating PFUI while minimizing well-known complications of traditional excision and primary anastomotic posterior urethroplasty such as de novo erectile dysfunction. Proximal urethral suturing is a challenging aspect of posterior urethroplasty but can be mastered through practice on a suturing model.http://www.sciencedirect.com/science/article/pii/S2590089720300360Non-transectingExcision and primary anastomosisUrethroplastyPelvic fractureUrethral trauma |
| spellingShingle | Min Suk Jun Peggy Gluszak Lee C. Zhao Nontransecting anastomotic urethroplasty of pelvic fracture urethral injury: A demonstration of technique Urology Video Journal Non-transecting Excision and primary anastomosis Urethroplasty Pelvic fracture Urethral trauma |
| title | Nontransecting anastomotic urethroplasty of pelvic fracture urethral injury: A demonstration of technique |
| title_full | Nontransecting anastomotic urethroplasty of pelvic fracture urethral injury: A demonstration of technique |
| title_fullStr | Nontransecting anastomotic urethroplasty of pelvic fracture urethral injury: A demonstration of technique |
| title_full_unstemmed | Nontransecting anastomotic urethroplasty of pelvic fracture urethral injury: A demonstration of technique |
| title_short | Nontransecting anastomotic urethroplasty of pelvic fracture urethral injury: A demonstration of technique |
| title_sort | nontransecting anastomotic urethroplasty of pelvic fracture urethral injury a demonstration of technique |
| topic | Non-transecting Excision and primary anastomosis Urethroplasty Pelvic fracture Urethral trauma |
| url | http://www.sciencedirect.com/science/article/pii/S2590089720300360 |
| work_keys_str_mv | AT minsukjun nontransectinganastomoticurethroplastyofpelvicfractureurethralinjuryademonstrationoftechnique AT peggygluszak nontransectinganastomoticurethroplastyofpelvicfractureurethralinjuryademonstrationoftechnique AT leeczhao nontransectinganastomoticurethroplastyofpelvicfractureurethralinjuryademonstrationoftechnique |