Predictors of elaborated perineal or a combined abdominoperineal approach during repair for pelvic fracture urethral injury
Purpose A step-based anastomotic urethroplasty is a standard technique for repairing the posterior urethra in patients with pelvic fracture urethral injury (PFUI). We aim to identify pre-operative factors, including results of conventional radiological imaging, for prediction of elaborated perineal...
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Published in | World journal of urology Vol. 42; no. 1; p. 40 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
20.01.2024
Springer Nature B.V |
Subjects | |
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Abstract | Purpose
A step-based anastomotic urethroplasty is a standard technique for repairing the posterior urethra in patients with pelvic fracture urethral injury (PFUI). We aim to identify pre-operative factors, including results of conventional radiological imaging, for prediction of elaborated perineal or a combined abdominoperineal procedure.
Methods
Retrospective observational study on 114 consecutive patients undergoing urethroplasty for PFUI between January 2020 and December 2022 was conducted. Surgical procedures were categorized according to the Webster classification into two groups: steps 1–2 (group 1) and steps 3–4 or a combined abdominoperineal repair (group 2). Pre-operative pattern results of RGU/VCUG were categorized regarding the relation between the proximal urethral stump with the pubic symphysis: posterior urethral stump below (pattern 1) or above (pattern 2) the lower margin of the pubic symphysis. Patient demographics were assessed. Univariate and multivariate logistic regression analyses were utilized.
Results
Overall, 102 patients were enrolled in the study for data analysis. On the multivariate logistic regression analysis, the presence of erectile dysfunction (OR 4.5;
p
= 0.014), prior combined treatment (endoscopic and urethroplasty) (OR 6.4;
p
= 0.018) and RGU/VCUG pattern 2 (OR 66;
p
< 0.001) significantly increased the likelihood of the need of step 3 or higher.
Conclusions
The need of step 3 or higher during urethroplasty for PFUI can be predicted pre-operatively with conventional imaging (RGU/VCUG). Patients with proximal urethral stump above the lower margin of pubic symphysis were about 66 times more likely to need step 3 or higher during urethroplasty. |
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AbstractList | PURPOSEA step-based anastomotic urethroplasty is a standard technique for repairing the posterior urethra in patients with pelvic fracture urethral injury (PFUI). We aim to identify pre-operative factors, including results of conventional radiological imaging, for prediction of elaborated perineal or a combined abdominoperineal procedure.METHODSRetrospective observational study on 114 consecutive patients undergoing urethroplasty for PFUI between January 2020 and December 2022 was conducted. Surgical procedures were categorized according to the Webster classification into two groups: steps 1-2 (group 1) and steps 3-4 or a combined abdominoperineal repair (group 2). Pre-operative pattern results of RGU/VCUG were categorized regarding the relation between the proximal urethral stump with the pubic symphysis: posterior urethral stump below (pattern 1) or above (pattern 2) the lower margin of the pubic symphysis. Patient demographics were assessed. Univariate and multivariate logistic regression analyses were utilized.RESULTSOverall, 102 patients were enrolled in the study for data analysis. On the multivariate logistic regression analysis, the presence of erectile dysfunction (OR 4.5; p = 0.014), prior combined treatment (endoscopic and urethroplasty) (OR 6.4; p = 0.018) and RGU/VCUG pattern 2 (OR 66; p < 0.001) significantly increased the likelihood of the need of step 3 or higher.CONCLUSIONSThe need of step 3 or higher during urethroplasty for PFUI can be predicted pre-operatively with conventional imaging (RGU/VCUG). Patients with proximal urethral stump above the lower margin of pubic symphysis were about 66 times more likely to need step 3 or higher during urethroplasty. Purpose A step-based anastomotic urethroplasty is a standard technique for repairing the posterior urethra in patients with pelvic fracture urethral injury (PFUI). We aim to identify pre-operative factors, including results of conventional radiological imaging, for prediction of elaborated perineal or a combined abdominoperineal procedure. Methods Retrospective observational study on 114 consecutive patients undergoing urethroplasty for PFUI between January 2020 and December 2022 was conducted. Surgical procedures were categorized according to the Webster classification into two groups: steps 1–2 (group 1) and steps 3–4 or a combined abdominoperineal repair (group 2). Pre-operative pattern results of RGU/VCUG were categorized regarding the relation between the proximal urethral stump with the pubic symphysis: posterior urethral stump below (pattern 1) or above (pattern 2) the lower margin of the pubic symphysis. Patient demographics were assessed. Univariate and multivariate logistic regression analyses were utilized. Results Overall, 102 patients were enrolled in the study for data analysis. On the multivariate logistic regression analysis, the presence of erectile dysfunction (OR 4.5; p = 0.014), prior combined treatment (endoscopic and urethroplasty) (OR 6.4; p = 0.018) and RGU/VCUG pattern 2 (OR 66; p < 0.001) significantly increased the likelihood of the need of step 3 or higher. Conclusions The need of step 3 or higher during urethroplasty for PFUI can be predicted pre-operatively with conventional imaging (RGU/VCUG). Patients with proximal urethral stump above the lower margin of pubic symphysis were about 66 times more likely to need step 3 or higher during urethroplasty. A step-based anastomotic urethroplasty is a standard technique for repairing the posterior urethra in patients with pelvic fracture urethral injury (PFUI). We aim to identify pre-operative factors, including results of conventional radiological imaging, for prediction of elaborated perineal or a combined abdominoperineal procedure. Retrospective observational study on 114 consecutive patients undergoing urethroplasty for PFUI between January 2020 and December 2022 was conducted. Surgical procedures were categorized according to the Webster classification into two groups: steps 1-2 (group 1) and steps 3-4 or a combined abdominoperineal repair (group 2). Pre-operative pattern results of RGU/VCUG were categorized regarding the relation between the proximal urethral stump with the pubic symphysis: posterior urethral stump below (pattern 1) or above (pattern 2) the lower margin of the pubic symphysis. Patient demographics were assessed. Univariate and multivariate logistic regression analyses were utilized. Overall, 102 patients were enrolled in the study for data analysis. On the multivariate logistic regression analysis, the presence of erectile dysfunction (OR 4.5; p = 0.014), prior combined treatment (endoscopic and urethroplasty) (OR 6.4; p = 0.018) and RGU/VCUG pattern 2 (OR 66; p < 0.001) significantly increased the likelihood of the need of step 3 or higher. The need of step 3 or higher during urethroplasty for PFUI can be predicted pre-operatively with conventional imaging (RGU/VCUG). Patients with proximal urethral stump above the lower margin of pubic symphysis were about 66 times more likely to need step 3 or higher during urethroplasty. |
ArticleNumber | 40 |
Author | Joshi, Pankaj M. Kulkarni, Sanjay B. Bhadranavar, Shreyas Oszczudlowski, Maciej Anand, Apurva Yepes, Christian |
Author_xml | – sequence: 1 givenname: Christian orcidid: 0000-0002-7191-6599 surname: Yepes fullname: Yepes, Christian email: chrisye14@gmail.com organization: Center for Genital Reconstructive Surgery, Kulkarni Uro Surgery Institute – sequence: 2 givenname: Maciej surname: Oszczudlowski fullname: Oszczudlowski, Maciej organization: Urology Clinic, Centre of Postgraduate Medical Education – sequence: 3 givenname: Pankaj M. surname: Joshi fullname: Joshi, Pankaj M. organization: Kulkarni Uro Surgery Institute – sequence: 4 givenname: Apurva surname: Anand fullname: Anand, Apurva organization: Kulkarni Uro Surgery Institute – sequence: 5 givenname: Shreyas surname: Bhadranavar fullname: Bhadranavar, Shreyas organization: Kulkarni Uro Surgery Institute – sequence: 6 givenname: Sanjay B. surname: Kulkarni fullname: Kulkarni, Sanjay B. organization: Kulkarni Uro Surgery Institute |
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Cites_doi | 10.1016/j.juro.2008.01.041 10.1007/s00345-021-03764-9 10.1111/j.1464-410X.1995.tb07234.x 10.1007/s003450050046 10.1016/S0022-5347(17)38442-2 10.1111/j.1464-410X.2005.05774.x 10.5152/tud.2020.20472 10.1097/01.ju.0000152252.48176.69 10.1016/S0022-5347(17)45609-6 10.1016/j.aju.2015.01.002 10.1016/j.urology.2013.09.011 10.5152/tud.2018.57699 10.1097/01.ju.0000076752.32199.40 10.1259/bjr.20211034 10.1016/j.juro.2009.11.045 10.1097/00005392-199501000-00024 10.1016/j.juro.2008.10.170 10.1007/s00345-019-02824-5 10.1016/j.juro.2009.06.022 10.1016/j.urology.2013.09.009 10.3390/jcm12062427 10.1016/S0039-6109(16)39642-6 10.1016/j.juro.2006.11.036 |
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Keywords | Inferior wedge pubectomy Retrograde urethrography Voiding cystourethrography Anastomotic urethroplasty |
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A step-based anastomotic urethroplasty is a standard technique for repairing the posterior urethra in patients with pelvic fracture urethral injury... A step-based anastomotic urethroplasty is a standard technique for repairing the posterior urethra in patients with pelvic fracture urethral injury (PFUI). We... PurposeA step-based anastomotic urethroplasty is a standard technique for repairing the posterior urethra in patients with pelvic fracture urethral injury... PURPOSEA step-based anastomotic urethroplasty is a standard technique for repairing the posterior urethra in patients with pelvic fracture urethral injury... |
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SubjectTerms | Erectile Dysfunction Fractures, Bone - complications Fractures, Bone - surgery Humans Male Medicine Medicine & Public Health Nephrology Oncology Original Article Pelvic Bones - injuries Perineum Regression analysis Retrospective Studies Treatment Outcome Urethra Urethra - injuries Urethra - surgery Urethral Stricture - surgery Urology |
Title | Predictors of elaborated perineal or a combined abdominoperineal approach during repair for pelvic fracture urethral injury |
URI | https://link.springer.com/article/10.1007/s00345-023-04733-0 https://www.ncbi.nlm.nih.gov/pubmed/38244107 https://www.proquest.com/docview/2916728697/abstract/ https://search.proquest.com/docview/2917556576 |
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