V05-10: Surgical technique: Posterior urethroplasty for pelvic fracture urethral urethral injury
Posterior urethroplasty is the standard of care for pelvic fracture urethral injuries (PFUI). Adjunctive manoeuvres such as corporal splitting, infrapubectomy and corporal rerouting are sometimes necessary to achieve a tension-free anastomosis. Corporal rerouting is rarely necessary, therefore rarely performed. Our objective is to detail the surgical steps and technique for the above-mentioned procedures.
Our case is that of a 14-year-old boy with PFUI secondary to a motor vehicle accident. The patent was initially managed with a percutaneous suprapubic tube and underwent urethral rest for 3 months. Pre-operative combined retrograde urethrogram and antegrade flexible cystoscopy showed a 6cm distraction defect. Posterior urethroplasty was performed, using corporal splitting, infrapubectomy and corporal rerouting, as detailed in the video.
The post-operative course was uneventuful and post-operative imaging perfomed 1 month later showed an open and patient urethra with no extravasation. The patient was doing well at his 6-month post-operative visit.
Adjunctive manoeuvres during posterior urethroplasty may be necessary to obtain a tension-free anastomosis. Knowledge of the surgical techniques is essential for successful surgical outcomes.