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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (4): 646-650. doi: 10.19723/j.issn.1671-167X.2020.04.009

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Combined transperineal and transpubic urethroplasty for patients with complex male pelvic fracture urethral distraction defect

Jian-wei WANG,Li-bo MAN(),Xiao XU,Zhen-hua LIU,Feng HE,Guang-lin HUANG,Jian-po ZHAI,Ning ZHOU,Wei LI   

  1. Department of Urology, Beijing Jishuitan Hospital, the Fourth Medical College of Peking University, Beijing 100096, China
  • Received:2020-04-09 Online:2020-08-18 Published:2020-08-06
  • Contact: Li-bo MAN E-mail:manlibo@yeah.net

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Abstract:

Objective: To evaluate the clinical effects and characteristics of combined transperineal and transpubic urethroplasty for patients with complex pelvic fracture urethral distraction defect (PFUDD). Methods: We retrospectively reviewed the clinical data of 17 male patients with complex posterior PFUDD from January 2010 to December 2019. The complications included urethrorectal fistulas in 2 patients (11.8%), urethroperineal fistula in 1 patient (5.9%). Ten patients had undergone previous treatments: dilatation in 3 patients (17.6%), internal urethrotomy in 1 patient, failed urethroplasty in 6 patients (35.3%), of whom 2 patients had two times of failed urethroplasties. All the patients were performed with urethroplasty by combined transperineal and transpubic approach with removing the entire pubic bone followed by the anastomosis. Results: The mean age of the patients included in this study was 35.5 (range: 21-62) years. The mean length of stricture was 5.5 (range: 4.5-7.0) cm, the mean follow-up was 27 (range: 7-110) months, the mean time of operation was 190 (range: 150-260) min, the mean evaluated blood loss was 460 (range: 200-1 200) mL. There were 5 patients who needed blood transfusion intraoperatively or postoperatively. Wound infection was seen in 4 out of 17 patients and thrombosis of lower extremities in 1 out of 17 patients. The last follow-up showed that the mean postoperative maximum urinary flow rate was 22.7 (range: 15.5-40.7) mL/s. After removing the catheter, one patient presented with decreased urinary flow and symptoms of urinary infection. Cystoscopy showed the recurrent anastomotic stricture, which was cured by internal urethrotomy. In our series, the success rate of the combined transperineal and transpubic urethroplasty was 94.1% (16/17). Conclusion: Combined transperineal and transpubic urtheroplasty can achieve a tension free anastomosis after removing the entire wedge of pubis in some patients with complex PFUDD. However, this procedure should be completed in a regional referral hospital due to the complexity of the operation and the high percentage of complications.

Key words: Posterior urethral anastomotic urethroplasty, Pelvic urethral distraction defect, Pubectomy

CLC Number: 

  • R699.6

Figure 1

Circumferentially mobilizing bulbar urethra by perineal approach"

Figure 2

Pubectomy with osteotomy"

Figure 3

Make sure the patency of urethra without false passage by the cystoscopy"

Figure 4

Satisfactory mobilization of the proximal and distal urethra"

Figure 5

Omental pedicle covering and surrounding the anastomosis"

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[1] WANG Jian-wei,XU Xiao,BAO Zheng-qing,LIU Zhen-hua,HE Feng,HUANG Guang-lin,MAN Li-bo. Outcomes of partial pubectomy assisted anastomotic urethroplasty for male patients with pelvic fracture urethral distraction defect [J]. Journal of Peking University (Health Sciences), 2021, 53(4): 798-802.
[2] WANG Jian-wei, MAN Li-bo, HUANG Guang-lin, WANG Hai, Xu Xiao, ZHU Xiao-fei, LI Wei, LIU Zhen-hua. “3-step” strategy of transperineal anastomotic urethroplasty for the simple pelvic fracture urethral distraction defect in male patients [J]. Journal of Peking University(Health Sciences), 2018, 50(4): 617-620.
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