V8-06: Early Endoscopic Realignment for Pelvic Fracture Urethral Injury
The controversy over primary urethral realignment versus suprapubic tube placement following pelvic fracture urethral injury (PFUI) centers on feasibility and prolonged operative time required for realignment. We demonstrate an efficient and reproducible approach for successful early endoscopic realignment of PFUI.
Video recording of a patient with PFUI who initially underwent percutaneous SP cystostomy and 2 days later underwent early endoscopic realignment. Consent for filming was obtained. We demonstrate the necessary equipment, setup, and steps to accomplish endoscopic urethral realignment.
Early endoscopic realignment requires 2 flexible cystoscopes (each with a separate video tower, light source and camera), two wires, a dilator set, C-arm fluoroscopy and contrast, and a council tip catheter. The patient should be positioned supine with their suprapubic tube prepped into the field, with video towers at the head and the foot with the C-arm positioned over the pelvis. The suprapubic tract is dilated and an access sheath that can accommodate a flexible cystoscope is placed. Two cystoscopes are used – one through the urethra and the other through the suprapubic tract – and advanced to the site of the injury. C-arm is used to align the scopes in the A-P and oblique views. The cystoscopes are brought to one another using the scope’s light source as a guide. A wire is placed through one scope and into the other to establish through-and-through access. A council tip catheter is then placed over the wire. The procedure typically takes 20-30 minutes to perform.
Urethral realignment can be accomplished efficiently, successfully, and in an elective setting. Once realignment has been performed, patients should have early referral to a reconstructive urologist to determine further management.