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Optimising the outcome after anastomotic posterior urethroplasty
OBJECTIVES: To develop a plan that would optimise the outcome after an anastomotic repair of a pelvic fracture urethral injury (PFUI). METHODS: Data on the delayed repair of PFUI from reports in English were critically reviewed. The search criteria included reports by high-volume surgeons and those...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2015
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434834/ https://www.ncbi.nlm.nih.gov/pubmed/26019975 http://dx.doi.org/10.1016/j.aju.2014.12.006 |
Sumario: | OBJECTIVES: To develop a plan that would optimise the outcome after an anastomotic repair of a pelvic fracture urethral injury (PFUI). METHODS: Data on the delayed repair of PFUI from reports in English were critically reviewed. The search criteria included reports by high-volume surgeons and those from tertiary centres of reconstructive urethral surgery. RESULTS: The delayed repair of a PFUI should not be attempted within 4–6 months of the initial trauma. A tension-free, scar-free and mucosa-to-mucosa urethral anastomosis is critically important for a successful outcome. Urethral defects shorter than a third of the bulbar urethral length can usually be repaired by a simple perineal operation, while longer defects usually need an elaborated perineal or perineo-abdominal transpubic procedure. The finest suture that provides adequate strength should always be used for a urethral anastomosis, generally 3/0 polyglactin 910 for adult patients and 4/0 for children. In transpubic urethroplasty, an omental wrapping of the intra-abdominal segment of the bulbar urethra and the site of anastomosis is mandatory. CONCLUSIONS: Anastomotic repair of a PFUI entails various surgical components, and the importance of each of these should not be underestimated. Careful attention to these surgical components is mandatory for a successful outcome after repair. |
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