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Novel method of primary endoscopic realignment for high-grade posterior urethral injuries: A case report

BACKGROUND: A male urethral disruption injury is a urological emergency. Primary endoscopic realignment (PER) refers to reestablishment of urethral alignment via indwelling urethral catheter by cystoscope, which is recommended as the optimal emergent treatment approach for reducing the likelihood of...

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Autores principales: Ho, Cheng-Ju, Yang, Min-Hsin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8790438/
https://www.ncbi.nlm.nih.gov/pubmed/35127919
http://dx.doi.org/10.12998/wjcc.v10.i3.1050
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author Ho, Cheng-Ju
Yang, Min-Hsin
author_facet Ho, Cheng-Ju
Yang, Min-Hsin
author_sort Ho, Cheng-Ju
collection PubMed
description BACKGROUND: A male urethral disruption injury is a urological emergency. Primary endoscopic realignment (PER) refers to reestablishment of urethral alignment via indwelling urethral catheter by cystoscope, which is recommended as the optimal emergent treatment approach for reducing the likelihood of complications following injury. However, the prior literature suggests the success rate of PER to be relatively low due to complicated urethral disruption. We report a modified PER approach that serves to improve both the success rate and safety of the treatment. CASE SUMMARY: A 19-year-old male patient presented with multiple pelvic fractures and complete urethral disruption following a high-velocity traffic accident. The patient’s abdominal computed tomography and retrograde urethrography results revealed complete urethral disruption at the bulbar urethra, with hematoma and contrast medium extravasation that extended into the extraperitoneal space. The conventional retrograde PER by cystoscope failed due to severe disruption and considerable hematoma. Modified simultaneous antegrade and retrograde PER was performed by means of semi-rigid ureteroscopy via a suprapubic Foley catheter and cystoscopy via the external urethra. An antegrade guidewire was passed through the bladder neck and then pulled out through the external urethral meatus with a cystoscope. Urethral continuity was achieved after a 16-Fr silicone Foley catheter was indwelled into the bladder along the guidewire. The patient recovered well, achieving voiding continence and avoiding further operation for urethral stricture. CONCLUSION: Modified PER via suprapubic Foley catheter represents a promising and safe treatment approach in patients with posterior urethral injuries.
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spelling pubmed-87904382022-02-03 Novel method of primary endoscopic realignment for high-grade posterior urethral injuries: A case report Ho, Cheng-Ju Yang, Min-Hsin World J Clin Cases Case Report BACKGROUND: A male urethral disruption injury is a urological emergency. Primary endoscopic realignment (PER) refers to reestablishment of urethral alignment via indwelling urethral catheter by cystoscope, which is recommended as the optimal emergent treatment approach for reducing the likelihood of complications following injury. However, the prior literature suggests the success rate of PER to be relatively low due to complicated urethral disruption. We report a modified PER approach that serves to improve both the success rate and safety of the treatment. CASE SUMMARY: A 19-year-old male patient presented with multiple pelvic fractures and complete urethral disruption following a high-velocity traffic accident. The patient’s abdominal computed tomography and retrograde urethrography results revealed complete urethral disruption at the bulbar urethra, with hematoma and contrast medium extravasation that extended into the extraperitoneal space. The conventional retrograde PER by cystoscope failed due to severe disruption and considerable hematoma. Modified simultaneous antegrade and retrograde PER was performed by means of semi-rigid ureteroscopy via a suprapubic Foley catheter and cystoscopy via the external urethra. An antegrade guidewire was passed through the bladder neck and then pulled out through the external urethral meatus with a cystoscope. Urethral continuity was achieved after a 16-Fr silicone Foley catheter was indwelled into the bladder along the guidewire. The patient recovered well, achieving voiding continence and avoiding further operation for urethral stricture. CONCLUSION: Modified PER via suprapubic Foley catheter represents a promising and safe treatment approach in patients with posterior urethral injuries. Baishideng Publishing Group Inc 2022-01-21 2022-01-21 /pmc/articles/PMC8790438/ /pubmed/35127919 http://dx.doi.org/10.12998/wjcc.v10.i3.1050 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Case Report
Ho, Cheng-Ju
Yang, Min-Hsin
Novel method of primary endoscopic realignment for high-grade posterior urethral injuries: A case report
title Novel method of primary endoscopic realignment for high-grade posterior urethral injuries: A case report
title_full Novel method of primary endoscopic realignment for high-grade posterior urethral injuries: A case report
title_fullStr Novel method of primary endoscopic realignment for high-grade posterior urethral injuries: A case report
title_full_unstemmed Novel method of primary endoscopic realignment for high-grade posterior urethral injuries: A case report
title_short Novel method of primary endoscopic realignment for high-grade posterior urethral injuries: A case report
title_sort novel method of primary endoscopic realignment for high-grade posterior urethral injuries: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8790438/
https://www.ncbi.nlm.nih.gov/pubmed/35127919
http://dx.doi.org/10.12998/wjcc.v10.i3.1050
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