MP32-04 28 YEARS OF EXPERTISE: OPTIMIZING TREATMENT STRATEGIES FOR PELVIC FRACTURES AND COMPLEX URETHRAL INJURIES WITH a COMPREHENSIVE APPROACH

You have accessJournal of UrologyReconstruction: Urethral Reconstruction (Including Stricture) II (MP32)1 May 2024MP32-04 28 YEARS OF EXPERTISE: OPTIMIZING TREATMENT STRATEGIES FOR PELVIC FRACTURES AND COMPLEX URETHRAL INJURIES WITH a COMPREHENSIVE APPROACH María A. Ocampo, Jimena Navarro, Pankaj M. Joshi, Shreyas Bhadranavar, Parth Barot, Amey Tapallikar, and Sanjay B. Kulkarni María A. OcampoMaría A. Ocampo , Jimena NavarroJimena Navarro , Pankaj M. JoshiPankaj M. Joshi , Shreyas BhadranavarShreyas Bhadranavar , Parth BarotParth Barot , Amey TapallikarAmey Tapallikar , and Sanjay B. KulkarniSanjay B. Kulkarni View All Author Informationhttps://doi.org/10.1097/01.JU.0001008816.80828.35.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence of pelvic fracture urethral injuries (PFUI) is increasing worldwide, currently standing at 10%. PFUIs are categorized as simple or complex; simple cases can often be successfully managed with a single anastomotic procedure. However, complex cases pose significant challenges, leading to lower success rates, necessitating the expertise of experienced professionals. Among complex PFUI patients, re-redo urethroplasty and bulbar urethral necrosis (BUN) present particularly challenging scenarios. Our objective is to elucidate the management of these scenarios, drawing on the lessons learned from our 28 years of experience in treating complex PFUI patients. METHODS: We are a tertiary referral institute with a maintained database with follow up from 1995-2023. Among the 1339 PFUI cases we have handled, 359 were complex. For this analysis, we focused on patients undergoing re-redo urethroplasty and those with bulbar urethral necrosis. This is a descriptive, retrospective study, a total of 229 patients completed the follow-up and were included in analysis with prior approval from the ethics committee. We define success as the absence of additional procedures or catheter placement. RESULTS: We included 90 patients who had more than two failed urethroplasties, with a mean follow-up of 26 months. Of these, the majority of patients (55%) needed a step 3B urethroplasty, followed by step 2 in 28% of cases. The overall success rate was of 82.2%. We have operated 139 cases of BUN. The most common surgical technique used was the pedicle preputial tube in 94 patients with a success rate of 82.9%, followed by pedicle prepuce as onlay augmentation with dorsal buccal mucosa graft in 16 patients, with a success rate of 89.1%. In our cohort of patients with BUN, the overall success rate is 76.2% regarding the different techniques. CONCLUSIONS: Complex PFUI cases present significant challenges to the reconstructive urologists. Our study demonstrates that in experienced hands, the success rate of re-redo urethroplasty can match that of primary PFUI cases. Conversely, BUN, though unfortunate, can be effectively treated using different techniques, boasting high success rates. Tailoring the treatment to each patient individually and employing appropriate surgical techniques are crucial factors contributing to success. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e515 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information María A. Ocampo More articles by this author Jimena Navarro More articles by this author Pankaj M. Joshi More articles by this author Shreyas Bhadranavar More articles by this author Parth Barot More articles by this author Amey Tapallikar More articles by this author Sanjay B. Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...