Photo Credit: Salah Uddin
The following is a summary of “Retrospective analysis of urethral anastomosis with ancillary maneuvers and intraoperative biaxial defect measurements to achieve a tension-free guidance system for redo PFUDD treatment,” published in the April 2024 issue of Urology by Zhang et al.
Pelvic fracture urethral distraction defects (PFUDDs) present significant challenges in redo surgery due to lengthy defects and heightened tension, often leading to recurrence. Despite various ancillary maneuvers offering tension relief, a lack of consensus or guidelines hinders their selection. Here, the researchers share the center’s experience developing an intraoperative guidance system to achieve tension-free urethral anastomosis.
About 91 patients with recurrent PFUDDs treated between 2020 and 2022 were retrospectively reviewed. Scar removal and urethral anastomosis were performed, with six tension-relieving maneuvers utilized for long and high-tension defects. Preoperative urethrogram assessment and intraoperative biaxial defect measurements (vertical and horizontal) guided surgical planning. Patients were followed up for 12 months (8.9 ± 4.2), with recurrence and complications analyzed.
The overall success rate was 86.81%. The urethrogram revealed a mean defect of 2.9 ± 1.1 cm. Simple anastomosis (27 cases) yielded an 11.11% recurrence rate for defects < 2 cm. Cavernous septum splitting (24 cases) for defects > 2 cm horizontally resulted in 8.33% recurrence. Inferior pubectomy (21 cases) for defects > 3 cm horizontally saw a 19.05% recurrence rate. Ancillary distal urethra manipulations (15 cases) for 3-4 cm vertical defects yielded a 13.33% recurrence rate. Rerouting (4 cases) for vertical defects > 4 cm resulted in a 25.00% recurrence rate.
Ancillary maneuvers effectively reduce tension in redoing urethral anastomosis. Biaxial defect measurements aid in selecting appropriate maneuvers and combined strategies are recommended based on defect direction and length to achieve tension-free anastomosis. This comprehensive approach enhances the success of redoing PFUDD treatment.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01456-1