Pelvic fracture posterior urethral injury repaired by progressive perineal approach: A brief review of the literature

Lesiones de uretra posterior secundarias a fractura pélvica tratadas a través de abordaje perineal progresivo. Breve revisión de la literatura

Objective: To evaluate the postoperative outcomes of our patients with posterior urethral traumatic rupture repaired by progressive perineal approach, and to conduct a brief review of the literature.
Materials and methods: The clinical records of 7 patients aged between 2 to 12 years with urethral injuries due to pelvic fracture produced between March 2005 and January 2017, were reviewed. A suprapubic cystostomy for urinary drainage was constructed in the 7 patients immediately after diagnosis; two of them had concomitant rectum injuries thus a Hartmann’s colostomy was also performed in them. The preliminary urologic appraisal for definite urethroplasty included a synchronous anterograde and retrograde cysto-urethrogram to determine separation of the urethral segments. The final selection of surgical procedure was delayed urethral repair by progressive perineal approach minimum 6 months after the trauma event.
Results: The mechanism of injury was, blunt trauma after being struck by a moving vehicle in 6 patients and a crash injury caused by an oil rocker in one patient. The urethral disruption was complete in all patients. Three patients developed surgical complications: 2 urethral strictures which improved with dilatation and one urethral-perineal fistula with spontaneous closure and no associated complications. All patients remain asymptomatic; no patient has required a redo urethroplasty.
Commentaries: Our findings through the implementation of this therapeutic approach are consistent with those reported in the literature.
Conclusions: Progressive perineal access allows performing an anastomotic urethroplasty with good clinical outcomes in most patients.

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