V12-08: Extraperitoneal Robot-Assisted Repair of a Pelvic Fracture Associated Urethral Injury
VideoIntroductions and Objectives
The gold standard for management of posterior urethral injuries has been a topic of debate. In this video, we demonstrate to our knowledge, the first case of successful management of a pelvic fracture associated urethral injury in a young male, with utilization of robot-assisted surgery.
Twenty-four hours following pelvic injury, a 25-year-old man underwent an extraperitoneal robotic bladder and urethral repair. Primary repair of the membranous urethra was performed with a concomitant extraperitoneal bladder injury repair. A suprapubic tube, Foley catheter and Blake drain were left in place.
Follow-up cystogram and peri-catheter urethrogram three weeks later showed no contrast extravasation. The suprapubic and urethral catheters were removed at 3 weeks and 5 weeks post-op respectively.. Flexible cystoscopy demonstrated a well-healed anastomosis. At the 3 and 6 months follow-up, the patients reports normal voiding and erectile function.
We present to our knowledge the first case of immediate management of a pelvic fracture associated urethral injury using robot-assistance. This contrasts with the traditional practice of immediate SP tube diversion and delayed urethroplasty 3- 6 months following injury. Immediate repair using a robot-assisted approach is worth considering as we seek to shorten the convalescence of our affected patients, with no long-term sequelae.