A Modified Endoscopic Primary Realignment of Severe Bulbar Urethral Injury

Zhang, Zejian1; Fang, Liekui2; Chen, Dong1; Li, Wei1; Peng, Naixiong1; Thakker, Parth U.3,4; Zhang, Yuanyuan3,4; Wang, Xisheng1

2021

10.1089/end.2020.0567

JOURNAL OF ENDOUROLOGY   影响因子和分区

0892-7790

1557-900X

["Purpose: Male urethral injury is a common urologic emergency in developing countries. Whether early or late treatment of urethral injuries is often multifactorial and controversial. The goal of this study is to determine whether early realignment can reduce postsurgical complications and evaluate the clinical feasibility of emergency endoscopic urethroplasty using single rigid ureteroscopy in the treatment of bulbar urethral severe injury.","Patients and Methods: Between September 2013 and March 2019, 15 male adult patients (mean age 35 years; from 21 to 62 years) with severe bulbar urethral injury were enrolled into the current study. The patients mainly presented with dysuria or painful urination (15/15, 100%), urethral bleeding (13/15, 86.7%), and urinary retention (11/15, 73.3%). Six of them had swelling of perineal or scrotal soft tissue, while four had testicular contusion. No pelvic fracture was found in all cases with CT scanning of the pelvic cavity. The bulbar urethral at grade IV was confirmed to be completely ruptured in all cases by endoscopy during operation. The modified endoscopic primary realignment was performed.","Results: This new urethral repair technique was effectively performed in all patients and none converted to open operation. Mean operation time was 42.3 +/- 11.5 minutes (28-52 minutes) and the mean Foley catheter indwelling time was 34.5 +/- 6.9 days (28-42 days). During a follow-up of 41.3 +/- 22.8 months (12-64 months), mild urethral strictures (grade I) (19.7 +/- 9.5 weeks, 10-27 weeks postsurgery) developed in 8 patients (53.3%) and then were all improved 2.1 +/- 0.8 months (1.3-2.9 months) after periodic dilatations of the urethra (4-10 times). Erectile dysfunction (ED) occurred in three patients (20%) after surgery, who recovered from mild ED to normal by administration with oral sildenafil (100 mg, three times a week) for 12 weeks. The International Index of Erectile Function-5 (IIEF-5) score was significantly improved after surgery (M +/- SD, 25 +/- 3) compared with before (16.4 +/- 3.5) (p < 0.05). No incontinence and other complications occurred in all cases.","Conclusions: Early endoscopic realignment via suprapubic puncture cystostomy by single rigid ureteroscopy provides an effective, feasible, and safe procedure for severe bulbar urethral injury."]

emergency endoscopic realignment urethroplasty anterior urethral complications

SCI

英语

通讯

Urology & Nephrology

Urology & Nephrology

WOS:000614593400001

MARY ANN LIEBERT, INC

CLINICAL MEDICINE

Web of Science

1.Guangdong Med Univ, Shenzhen Long Hua Dist Cent Hosp, Affiliated Cent Hosp Shenzhen Long Hua Dist, Dept Urol, Shenzhen, Peoples R China
2.Southern Univ Sci & Technol, Shenzhen Peoples Hosp 3, Urinary Surg Dept, Affiliated Hosp 2, Shenzhen, Peoples R China
3.Wake Forest Univ, Bowman Gray Sch Med, Dept Urol, Winston Salem, NC 27103 USA
4.Wake Forest Univ, Bowman Gray Sch Med, Inst Regenerat Med, Winston Salem, NC USA

Zhang, Zejian,Fang, Liekui,Chen, Dong,et al. A Modified Endoscopic Primary Realignment of Severe Bulbar Urethral Injury[J]. JOURNAL OF ENDOUROLOGY,2021,35(3).

Zhang, Zejian.,Fang, Liekui.,Chen, Dong.,Li, Wei.,Peng, Naixiong.,...&Wang, Xisheng.(2021).A Modified Endoscopic Primary Realignment of Severe Bulbar Urethral Injury.JOURNAL OF ENDOUROLOGY,35(3).

Zhang, Zejian,et al."A Modified Endoscopic Primary Realignment of Severe Bulbar Urethral Injury".JOURNAL OF ENDOUROLOGY 35.3(2021).