V12-01: Laparoscopic omentoplasty to support anastomotic urethroplasty in complex and redo pelvic fracture urethral defect patients

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Introductions and Objectives
Complex and redo urethroplasties can be challenging in patients with Pelvic Fracture Urethral Defects (PFUD). The wrapping of the anastomosis with omentum can help in filling the dead space created by the inferior pubectomy and scar excision, absorption of serous exudates, maintain suppleness around anastomosis, and decrease the rate of fistula formation. In this study we aim to report the technique, feasibility, safety and results of laparoscopic omentoplasty to support perineal anastomosis in complex and redo PFUD patients.

Methods
We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approach for urethroplasty in patients with complex and redo PFUD at a single center in Pune, India between January 2012 and February 2013. Patients with PFUD occurring after pelvic fracture urethral injury (PFUI) were included in the study, while anterior urethral strictures were excluded. The primary study outcome was the success rate of the surgical technique and the secondary outcome was to evaluate feasibility and safety of the procedure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Descriptive statistical analysis was done.

Results
Fifteen male patients with a median age of 19 years were included in the study. Seven patients were adolescents (12-18 years) and 8 (53.3%) adults (19-49 years). All patients underwent elaborated bulbo-membranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to envelope the anastomosis and to fill the perineal dead space. Of 15 patients 14 (93.3%) were successful and 1 (6.6%) failed. One adolescent boy 14 years old developed a recurrent stricture 2 months after the procedure and was managed using internal urethrotomy. Median follow up was 18 months (range 13 to 24).

Conclusions
In an era of minimally invasive surgery, this new laparoscopic omentoplasty technique can provide support to the anastomotic perineal urethroplasty in complex and redo PFUD patients

Funding: None for all authors except Walid Shahrour who received:_x000D_ 1- Quebec Urology Association (QUA) research award_x000D_ 2- McGill University Health Center (MUHC) traveling fellowship award