Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention
Introduction. Pelvic ring fracture with complex bone fragments displacement is associated with the urethral distraction injury in about 10% of cases. Emergency care for these patients includes the provision of trauma management and urinary diversion followed by delayed urethroplasty.Purpose of the s...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | Russian |
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State Budget Educational Institute of Higher Professional Education, Rostov State Medical University, Ministry Health of Russian Federation
2021-07-01
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| Series: | Vestnik Urologii |
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| Online Access: | https://www.urovest.ru/jour/article/view/449 |
| _version_ | 1797272155708194816 |
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| author | V. P. Glukhov A. V. Ilyash V. V. Mitusov D. O. Kubasov A. V. Pilieva Yu. V. Khoronko M. I. Kogan |
| author_facet | V. P. Glukhov A. V. Ilyash V. V. Mitusov D. O. Kubasov A. V. Pilieva Yu. V. Khoronko M. I. Kogan |
| author_sort | V. P. Glukhov |
| collection | DOAJ |
| description | Introduction. Pelvic ring fracture with complex bone fragments displacement is associated with the urethral distraction injury in about 10% of cases. Emergency care for these patients includes the provision of trauma management and urinary diversion followed by delayed urethroplasty.Purpose of the study. To determine the effect of extramedullary osteosynthesis in a pelvic ring fracture on the outcome of treatment in patients with post-traumatic urethral strictures.Materials and methods. The study included 17 patients with post-traumatic urethral strictures associated with pelvic ring fractures (Types B, C). The average age of the patients was 35.8 ± 10.2 (19 - 61) yrs. All patients underwent submerged osteosynthesis and cystostomy drainage as an emergency. Localization of strictures: 10 (58.8%) - membranous, 7 (41.2%) - bulbo-membranous. Length of strictures: 1.47 ± 0.5 (0.5 - 2.5) cm. Post-traumatic period: 6.6 ± 1.3 (4 - 10) mo.Results. All patients underwent anastomotic urethroplasty. No early postoperative complications were identified. Spontaneous urination was restored by 14 - 15 days in all patients. Early urethral stricture relapses were revealed in 9 (52.9%) patients during 3-mo follow-up. These patients underwent removal of the metal structures fixing the pelvic bones. Repeated urethroplasty was performed a month later. Subsequent relapses of urethral stricture were not detected in any of 17 cases with a median follow-up of 28 (12 - 128) mo.Conclusion. Surgical treatment of urethral strictures associated with a pelvic ring fracture and osteosynthesis is advisable after removal of the metal structures fixing the pelvic bones. This is since the excessed retropubic screws protrusion (> 0.2 - 0.3 mm) is associated with a large area of periurethral fibrous inflammation and causes high relapse risks of stricture disease (52.9%) in the case of urethral surgery preceding the removal of metal structures. |
| first_indexed | 2024-03-07T14:23:18Z |
| format | Article |
| id | doaj.art-7859ae0af2ff450fa3b6a3180dc0ea9e |
| institution | Directory Open Access Journal |
| issn | 2308-6424 |
| language | Russian |
| last_indexed | 2024-03-07T14:23:18Z |
| publishDate | 2021-07-01 |
| publisher | State Budget Educational Institute of Higher Professional Education, Rostov State Medical University, Ministry Health of Russian Federation |
| record_format | Article |
| series | Vestnik Urologii |
| spelling | doaj.art-7859ae0af2ff450fa3b6a3180dc0ea9e2024-03-06T08:56:05ZrusState Budget Educational Institute of Higher Professional Education, Rostov State Medical University, Ministry Health of Russian FederationVestnik Urologii2308-64242021-07-0192253310.21886/2308-6424-2021-9-2-25-33313Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and preventionV. P. Glukhov0A. V. Ilyash1V. V. Mitusov2D. O. Kubasov3A. V. Pilieva4Yu. V. Khoronko5M. I. Kogan6Rostov State Medical UniversityRostov State Medical UniversityRostov State Medical UniversityRostov State Medical UniversityRostov State Medical UniversityRostov State Medical UniversityRostov State Medical UniversityIntroduction. Pelvic ring fracture with complex bone fragments displacement is associated with the urethral distraction injury in about 10% of cases. Emergency care for these patients includes the provision of trauma management and urinary diversion followed by delayed urethroplasty.Purpose of the study. To determine the effect of extramedullary osteosynthesis in a pelvic ring fracture on the outcome of treatment in patients with post-traumatic urethral strictures.Materials and methods. The study included 17 patients with post-traumatic urethral strictures associated with pelvic ring fractures (Types B, C). The average age of the patients was 35.8 ± 10.2 (19 - 61) yrs. All patients underwent submerged osteosynthesis and cystostomy drainage as an emergency. Localization of strictures: 10 (58.8%) - membranous, 7 (41.2%) - bulbo-membranous. Length of strictures: 1.47 ± 0.5 (0.5 - 2.5) cm. Post-traumatic period: 6.6 ± 1.3 (4 - 10) mo.Results. All patients underwent anastomotic urethroplasty. No early postoperative complications were identified. Spontaneous urination was restored by 14 - 15 days in all patients. Early urethral stricture relapses were revealed in 9 (52.9%) patients during 3-mo follow-up. These patients underwent removal of the metal structures fixing the pelvic bones. Repeated urethroplasty was performed a month later. Subsequent relapses of urethral stricture were not detected in any of 17 cases with a median follow-up of 28 (12 - 128) mo.Conclusion. Surgical treatment of urethral strictures associated with a pelvic ring fracture and osteosynthesis is advisable after removal of the metal structures fixing the pelvic bones. This is since the excessed retropubic screws protrusion (> 0.2 - 0.3 mm) is associated with a large area of periurethral fibrous inflammation and causes high relapse risks of stricture disease (52.9%) in the case of urethral surgery preceding the removal of metal structures.https://www.urovest.ru/jour/article/view/449urethral stricturefracture of the pelvic bonesextra bone osteosynthesisresection of the urethraanastomotic urethroplastyrecurrent stricture |
| spellingShingle | V. P. Glukhov A. V. Ilyash V. V. Mitusov D. O. Kubasov A. V. Pilieva Yu. V. Khoronko M. I. Kogan Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention Vestnik Urologii urethral stricture fracture of the pelvic bones extra bone osteosynthesis resection of the urethra anastomotic urethroplasty recurrent stricture |
| title | Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention |
| title_full | Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention |
| title_fullStr | Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention |
| title_full_unstemmed | Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention |
| title_short | Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention |
| title_sort | relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis the features of treatment and prevention |
| topic | urethral stricture fracture of the pelvic bones extra bone osteosynthesis resection of the urethra anastomotic urethroplasty recurrent stricture |
| url | https://www.urovest.ru/jour/article/view/449 |
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