V1562: Primary repair of traumatic urethral injury with TUR and temporary stent insertion
VideoIntroduction and Objectives
Traumatic urethral injuries are difficult to manage, both to the patient, who experiences discomfort from prolonged diversion until delayed management, as well as the surgeon, who must manage severe fibrotic scarring and ensuing recurrent episodes. While primary realignment at the time of injury has been reported in several studies, such repairs have been shown to be more highly affected by recurrent strictures than delayed treatment. This proof of concept study presents acute management with primary realignment within 1 week of injury by purely transurethral measures, aided by anterograde light source passed through a cystostomy, and placement of removable urethral stents to inhibit stricture growth.
Patients receiving complete urethral rupture were directly admitted, following placement of a cystostomy diversion. The perineal hematoma was externally compressed for 1 week, after which an elective surgery was performed. Surgical procedures consisted of first realigning the disconnected urethra by combination of transurethral incision and transurethral resection of dehiscent tissue. The urethral path to the bladder was guided by an anterograde light source passed through the cystostomy and positioned as distally as possible through the proximal segment of the disconnected urethra. After reconnecting the urethra, a removable nitinol urethral stent was placed.
Currently seven patients have undergone the process. All patients were discharged within two days following surgery. Temporary urethral stents are removed at 1 year; currently only one patient reached sufficient follow up to remove his stent, and remains free of recurrence. All patients are showing good voiding functions free of complications and diversions.
Effective immediate primary realignment with temporary stent placement is an effective method to treat complete traumatic rupture of the urethra.