Outcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra: a single-center retrospective study
Abstract Background The optimal acute management of patients with blunt straddle injury to the bulbar urethra remains in question. Conventionally, suprapubic diversion with delayed urethroplasty can always be considered, if necessary, but the role of early endoscopic realignment (EER) in the acute m...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12893-022-01489-z |
| _version_ | 1819280464876142592 |
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| author | Jianwei Wang Zhengqing Bao Xiao Xu Zhenhua Liu Guizhong Li Guanglin Huang Libo Man |
| author_facet | Jianwei Wang Zhengqing Bao Xiao Xu Zhenhua Liu Guizhong Li Guanglin Huang Libo Man |
| author_sort | Jianwei Wang |
| collection | DOAJ |
| description | Abstract Background The optimal acute management of patients with blunt straddle injury to the bulbar urethra remains in question. Conventionally, suprapubic diversion with delayed urethroplasty can always be considered, if necessary, but the role of early endoscopic realignment (EER) in the acute management of blunt straddle injuries to bulbar urethra is controversial. We report our clinical experience and outcomes with EER for patients with straddle injury to the bulbar urethra in a level one trauma center. Methods We retrospectively reviewed 44 male patients who were transferred to our trauma center between January 2013 and January 2019 for acute management of blunt straddle injury to the perineum leading to bulbar urethra injuries. We reviewed the medical records of those patients to identify demographics, emergency management and clinical outcomes. Results The most common injury mechanism was falling onto the perineum (n = 27, 61.4%), followed by motorcycle accident (n = 11, 25.0%) and bicycle accident (n = 6, 13.6%). Of the 44 patients, 14 (31.8%) were partial bulbar urethral ruptures and 30 (68.2%) were complete bulbar urethral ruptures. 31 (70.5%) patients successfully underwent EER and 13 (29.5%) patients failed attempted EER. the difference between successful EER attempts and failed ones in term of injured urethral mucosa integrity was statistically significant (P = 0.035, OR 8.667,95% CI: 0.998–75.235). In patients who underwent successful EER, urethral stricture occurred after catheter removal at a median of 8 (1–28) months in 24 (77.4%) patients and the mean stricture length was 1.8 ± 0.8 (0.5–3.0), which was not statistically significant when compared with those who failed EER (P = 0.103). Overall, 21 out of 24 (87.5%) patients with strictures after EER were successfully managed by urethroplasty. Conclusions Although achieving a successful EER attempt is relatively easy for most patients with straddle injury to the bulbar urethra, it does not improve urethral healing significantly. Most patients with stricture formation after EER have to be cured with urethroplasty. |
| first_indexed | 2024-12-24T00:44:13Z |
| format | Article |
| id | doaj.art-3de30c20057c420093b1d7bb80fe2bab |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-24T00:44:13Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-3de30c20057c420093b1d7bb80fe2bab2022-12-21T17:23:52ZengBMCBMC Surgery1471-24822022-01-012211610.1186/s12893-022-01489-zOutcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra: a single-center retrospective studyJianwei Wang0Zhengqing Bao1Xiao Xu2Zhenhua Liu3Guizhong Li4Guanglin Huang5Libo Man6Urology Department, Beijing Jishuitan Hospital, The Fourth Medical College of Peking UniversityUrology Department, Beijing Jishuitan Hospital, The Fourth Medical College of Peking UniversityUrology Department, Beijing Jishuitan Hospital, The Fourth Medical College of Peking UniversityUrology Department, Beijing Jishuitan Hospital, The Fourth Medical College of Peking UniversityUrology Department, Beijing Jishuitan Hospital, The Fourth Medical College of Peking UniversityUrology Department, Beijing Jishuitan Hospital, The Fourth Medical College of Peking UniversityUrology Department, Beijing Jishuitan Hospital, The Fourth Medical College of Peking UniversityAbstract Background The optimal acute management of patients with blunt straddle injury to the bulbar urethra remains in question. Conventionally, suprapubic diversion with delayed urethroplasty can always be considered, if necessary, but the role of early endoscopic realignment (EER) in the acute management of blunt straddle injuries to bulbar urethra is controversial. We report our clinical experience and outcomes with EER for patients with straddle injury to the bulbar urethra in a level one trauma center. Methods We retrospectively reviewed 44 male patients who were transferred to our trauma center between January 2013 and January 2019 for acute management of blunt straddle injury to the perineum leading to bulbar urethra injuries. We reviewed the medical records of those patients to identify demographics, emergency management and clinical outcomes. Results The most common injury mechanism was falling onto the perineum (n = 27, 61.4%), followed by motorcycle accident (n = 11, 25.0%) and bicycle accident (n = 6, 13.6%). Of the 44 patients, 14 (31.8%) were partial bulbar urethral ruptures and 30 (68.2%) were complete bulbar urethral ruptures. 31 (70.5%) patients successfully underwent EER and 13 (29.5%) patients failed attempted EER. the difference between successful EER attempts and failed ones in term of injured urethral mucosa integrity was statistically significant (P = 0.035, OR 8.667,95% CI: 0.998–75.235). In patients who underwent successful EER, urethral stricture occurred after catheter removal at a median of 8 (1–28) months in 24 (77.4%) patients and the mean stricture length was 1.8 ± 0.8 (0.5–3.0), which was not statistically significant when compared with those who failed EER (P = 0.103). Overall, 21 out of 24 (87.5%) patients with strictures after EER were successfully managed by urethroplasty. Conclusions Although achieving a successful EER attempt is relatively easy for most patients with straddle injury to the bulbar urethra, it does not improve urethral healing significantly. Most patients with stricture formation after EER have to be cured with urethroplasty.https://doi.org/10.1186/s12893-022-01489-zUrethraUrethral obstructionWounds and injuriesCrush injuriesMinimally invasive surgery |
| spellingShingle | Jianwei Wang Zhengqing Bao Xiao Xu Zhenhua Liu Guizhong Li Guanglin Huang Libo Man Outcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra: a single-center retrospective study BMC Surgery Urethra Urethral obstruction Wounds and injuries Crush injuries Minimally invasive surgery |
| title | Outcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra: a single-center retrospective study |
| title_full | Outcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra: a single-center retrospective study |
| title_fullStr | Outcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra: a single-center retrospective study |
| title_full_unstemmed | Outcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra: a single-center retrospective study |
| title_short | Outcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra: a single-center retrospective study |
| title_sort | outcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra a single center retrospective study |
| topic | Urethra Urethral obstruction Wounds and injuries Crush injuries Minimally invasive surgery |
| url | https://doi.org/10.1186/s12893-022-01489-z |
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