Background Posterior urethral injuries are rare, patients usually are polytraumatized and with associated pelvic fracture, emergency management is mostly limited to the placement of an epicystostomy after retrograde urethrocystography. The most common definitive therapeutic options are primary endoscopic realignment and deferred urethroplasty, with an increasing diffusion of the first method. Typical long-term complications are represented by urethral stenosis, erectile dysfunction and urinary incontinence, responsible for significant morbidity in consideration of the usual young age of the patients and whose incidence and evolution depend on the correct management of the urethral lesion. Aim of the study The aim of the study was to evaluate, through a retrospective analysis of the cases of Urology Clinic University Hospital of Padua and a second hub center, the type of traumatic lesion of the urethra, in particular of the posterior tract, the modality of the early management and the type of definitive treatment (with a focus on primary endoscopic realignment) and long-term functional outcomes. Materials and methods Data available in the operative registers and in the medical records of the two UOCs of Urology were evaluated. The recruited patients were interviewed by telephone, administering to each patient the validated SIEDY, IIEF-5, IIEF-6 and PEDT questionnaires, and investigating the current condition of urinary flow and continence. Results Our results confirmed the frequent association between traumatic injury to the urethra and pelvic fractures secondary to major traumas, often caused by road accidents. All patients included in the study were of young age (<65 years) and the most frequently encountered type of lesion was a complete rupture at the bulb-membranous junction. Urethral strictures are a frequent long-term complication. Their endoscopic treatment is a good initial therapeutic option, but urethroplasty is required in recurrent cases. Even severe erectile dysfunction, on a vascular-nerve basis, is a frequent complication of both severe urethral traumas and their reparative surgical treatments, with limited possibility of improvement over time. Conclusions Primary endoscopic realignment has proved to be a valid treatment for posterior urethral injuries, reducing morbidity and complications. The complexity of traumatic urethral injuries and their relatively low frequency makes it necessary to manage these patients at hospitals that have an adequate number of cases and operational experience in order to guarantee high healing rates and low complication rates.
Background I traumi dell’uretra posteriore sono eventi rari, che frequentemente si verificano in pazienti politraumatizzati con fratture pelviche associate e la cui gestione in emergenza è per lo più limitata al posizionamento di un’epicistostomia previa uretrocistografia retrograda. Le opzioni terapeutiche più diffuse sono il riallineamento endoscopico primario e l’uretroplastica differita, con una diffusione sempre maggiore della prima metodica. Tipiche complicanze a lungo termine sono rappresentate da stenosi uretrali, disfunzione erettile ed incontinenza urinaria, responsabili di una significativa morbilità in considerazione della usuale giovane età dei pazienti e la cui incidenza ed evoluzione dipendono dalla corretta gestione della lesione uretrale. Scopo dello studio Lo scopo dello studio è stato valutare, attraverso un’analisi retrospettiva della casistica della Clinica Urologica della Azienda Ospedale - Università di Padova e di un secondo centro hub, la tipologia della lesione traumatica dell’uretra, in particolare del tratto posteriore, la modalità di gestione precoce ed il tipo di trattamento definitivo (con particolare attenzione al riallineamento endoscopico primario) e i risultati funzionali ottenuti a lungo termine. Materiali e metodi Sono stati valutati i dati disponibili nei registri operatori e nelle cartelle cliniche delle due UOC di Urologia. I pazienti reclutati sono stati intervistati telefonicamente, somministrando a ciascun paziente i questionari validati SIEDY, IIEF-5, IIEF-6 e PEDT, e indagando la condizione attuale di flusso urinario e continenza. Risultati I nostri risultati hanno confermato la frequente associazione tra lesione traumatica dell’uretra e fratture del bacino secondarie a traumatismi maggiori, spesso in corso di incidente stradale. Tutti i pazienti inclusi nello studio sono risultati di giovane età (<65 anni) e la tipologia di lesione più frequentemente riscontrata è stata una rottura completa a livello della giunzione bulbo-membranosa. Le stenosi uretrali sono una frequente complicanza a lungo termine. Il loro trattamento per via endoscopica rappresenta una buona opzione terapeutica iniziale ma nei casi plurirecidivanti è necessario un intervento di uretroplastica. Anche la disfunzione erettile di carattere severo, su base vascolo-nervosa, rappresenta una frequente complicanza sia dei traumatismi uretrali gravi che dei loro trattamenti chirurgici riparativi, con limitata possibilità di miglioramento nel tempo. Conclusioni Il riallineamento endoscopico primario si è dimostrato un valido trattamento per le lesioni dell’uretra posteriore riducendo morbilità e complicanze. La complessità delle lesioni uretrali traumatiche e la loro relativa ridotta frequenza rende necessaria una gestione di questi pazienti presso centri ospedalieri di riferimento, che vantino una casistica ed una esperienza operativa adeguata ai fini di garantire alti tassi di guarigione e basse percentuali di complicanze.
Risultati funzionali del riallineamento dopo trauma dell'uretra posteriore
BRAGAGNOLO, NICOLA
2021/2022
Abstract
Background Posterior urethral injuries are rare, patients usually are polytraumatized and with associated pelvic fracture, emergency management is mostly limited to the placement of an epicystostomy after retrograde urethrocystography. The most common definitive therapeutic options are primary endoscopic realignment and deferred urethroplasty, with an increasing diffusion of the first method. Typical long-term complications are represented by urethral stenosis, erectile dysfunction and urinary incontinence, responsible for significant morbidity in consideration of the usual young age of the patients and whose incidence and evolution depend on the correct management of the urethral lesion. Aim of the study The aim of the study was to evaluate, through a retrospective analysis of the cases of Urology Clinic University Hospital of Padua and a second hub center, the type of traumatic lesion of the urethra, in particular of the posterior tract, the modality of the early management and the type of definitive treatment (with a focus on primary endoscopic realignment) and long-term functional outcomes. Materials and methods Data available in the operative registers and in the medical records of the two UOCs of Urology were evaluated. The recruited patients were interviewed by telephone, administering to each patient the validated SIEDY, IIEF-5, IIEF-6 and PEDT questionnaires, and investigating the current condition of urinary flow and continence. Results Our results confirmed the frequent association between traumatic injury to the urethra and pelvic fractures secondary to major traumas, often caused by road accidents. All patients included in the study were of young age (<65 years) and the most frequently encountered type of lesion was a complete rupture at the bulb-membranous junction. Urethral strictures are a frequent long-term complication. Their endoscopic treatment is a good initial therapeutic option, but urethroplasty is required in recurrent cases. Even severe erectile dysfunction, on a vascular-nerve basis, is a frequent complication of both severe urethral traumas and their reparative surgical treatments, with limited possibility of improvement over time. Conclusions Primary endoscopic realignment has proved to be a valid treatment for posterior urethral injuries, reducing morbidity and complications. The complexity of traumatic urethral injuries and their relatively low frequency makes it necessary to manage these patients at hospitals that have an adequate number of cases and operational experience in order to guarantee high healing rates and low complication rates.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/10670