林口長庚紀念醫院 長庚大學 外科部 泌尿外科
Modified urethral pull through operation for complex pelvic fracture urethral injury – preliminary report
Pai-Yen, Pan, Ta-Min Wang, Hsu-Han Wang, Sheng-Hsien Chu, Yang-Jen Chiang,
Kou-Jen Lin, Chih-Te Lin
Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital,
Chang Gung University, Taoyuan, Taiwan
Purpose: We present our experience and technique of the modified urethral pull-through operation for complex pelvic fracture urethral injury.
Materials and Methods: A total of 10 patients with severe posttraumatic posterior urethral distraction defect resulting from pelvic fracture injury underwent the modified urethral pull-through operation at our department from August 2017 to August 2020. Patient age was 16 to 78 years (mean 43.7). The length of urethral distraction defect was 3.0 to 6.0 cm (mean 4.11). Follow up included Uroflowmetry evaluation, which was performed 1 to 2 months after operation in all patients and thereafter when needed, and urethrography and/or urethroscopy in patients with voiding symptoms. Clinical outcomes were considered a success when catheter free urination is achieved.
Results: Patients were followed for 2 to 33 months (mean 16.1). During that period 8 patients were symptom-free and required no further procedures. The men peak flow rate of all successful patients was 12.25 ml per second. No Recurrent stricture developed of them. All treatment failures occurred within the first 1 months postoperatively. Failed repairs were successfully managed repeating the pull-through operation in the 1 patient for a primary success rate of 80% and a final success rate of 90%. Three patients were mild incontinence. Erectile dysfunction was noted postoperatively in 6 patients (60%). There was no chordee, penile shortening.
Conclusions: The modified urethral pull-through operation is effective for the surgical treatment of severe posttraumatic posterior urethral stricture. It has a high success rate with durable long-term results. Complications are few. The procedure is a simple, salvage and alternative technique for urethroplasty, especially suitable in patients who had difficult and unreachable tension free primary anastomosis during operation.