V12-02: Pedicle Preputial Tube for Pelvic Fracture Urethral Defect and Ischemic Bulbar Urethra
VideoIntroductions and Objectives
Fortunately, bulbomembranous anatastamosis for Pelvic Fracture Urethra Defect (PFUD) has great success. However, some cases have bulbar urethral ischemia due to inadequate retrograde blood supply. Anastomotic urethroplasty is not possible and substitution urethroplasty using a perineal or abdominoperineal approach is required. We present our description of substitution urethroplasty with a Pedicle Preputial Tube (PPT) for such cases of inadequate bulbar urethral length.
A unique video of a stepwise approach to a difficult case, with accompanying narration of surgical management with PPT. Perineal dissection is performed in a standard stepwise format. Two circumcision incisions are made and the prepuce is mobilized into the perineum on the dartos flap. The Inner Prepuce is tubularized and utilized to bridge the long gap between the anterior and posterior urethra.
We have performed PPT for 23 patients. It is common for these patients to have post micturition dribble due to diverticulum formation of the skin-lined urethra. Flow rates are not reliable indicators of success or failure. They may occasionally need dilation.
Pedicle Preputial Tube, while not ideal, is a viable option for patients in whom a pubectomy has been performed for PFUD and have an ischemic or obliterated bulbar urethra.