Open AccessRelapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention
Author(s) -
В. П. Глухов,
А. В. Ильяш,
V.V. Mitusov,
Д. О. Кубасов,
Anastasia V. Pilieva,
Ю. В. Хоронько,
М. И. Коган
Publication year - 2021
Publication title -
vestnik urologii
Language(s) - English
Resource type - Journals
ISSN - 2308-6424
DOI - 10.21886/2308-6424-2021-9-2-25-33
Subject(s) - medicine , pelvic fracture , urethroplasty , surgery , osteosynthesis , suprapubic cystostomy , urethral stricture , urethra , pelvis
. Pelvic ring fracture with complex bone fragments displacement is associated with the urethral distraction injury in about 10% of cases. Emergency care for these patients includes the provision of trauma management and urinary diversion followed by delayed urethroplasty. Purpose of the study . To determine the effect of extramedullary osteosynthesis in a pelvic ring fracture on the outcome of treatment in patients with post-traumatic urethral strictures. Materials and methods . The study included 17 patients with post-traumatic urethral strictures associated with pelvic ring fractures (Types B, C). The average age of the patients was 35.8 ± 10.2 (19 - 61) yrs. All patients underwent submerged osteosynthesis and cystostomy drainage as an emergency. Localization of strictures: 10 (58.8%) - membranous, 7 (41.2%) - bulbo-membranous. Length of strictures: 1.47 ± 0.5 (0.5 - 2.5) cm. Post-traumatic period: 6.6 ± 1.3 (4 - 10) mo. Results . All patients underwent anastomotic urethroplasty. No early postoperative complications were identified. Spontaneous urination was restored by 14 - 15 days in all patients. Early urethral stricture relapses were revealed in 9 (52.9%) patients during 3-mo follow-up. These patients underwent removal of the metal structures fixing the pelvic bones. Repeated urethroplasty was performed a month later. Subsequent relapses of urethral stricture were not detected in any of 17 cases with a median follow-up of 28 (12 - 128) mo. Conclusion . Surgical treatment of urethral strictures associated with a pelvic ring fracture and osteosynthesis is advisable after removal of the metal structures fixing the pelvic bones. This is since the excessed retropubic screws protrusion (> 0.2 - 0.3 mm) is associated with a large area of periurethral fibrous inflammation and causes high relapse risks of stricture disease (52.9%) in the case of urethral surgery preceding the removal of metal structures.