Surgical Management of Posterior Urethral Distraction Injuries in University of Port Harcourt teaching hospital.

Abstract

Introduction: Posterior urethral distraction injuries repair remains a daunting surgery for the urologist. Surgical repair options include early endoscopic realignment and initial cystostomy with delayed anastomotic urethroplasty. Complications of urine incontinence, erectile dysfunction and stricture are also concerns. Objectives: To review our experience in urethroplasty for posterior urethral distraction injuries, the outcomes and complications. Methods: This was a retrospective study of Five (5) patients with posterior urethral distraction injuries managed from January 2017 to January 2019. They were all evaluated with retrograde urethrogram and voiding cystourethrogram. Pre-operative erectile function was assessed. The median time from injury to surgery was 14 months. In all cases, the area of fibrosis was aggressively excised and the urethra and corpus spongiosum were mobilized with tension free end to end spatulated anastomosis. Crural separation was done in 80% of cases and an additional inferior pubectomy was done in 60% of cases. Patients were followed up with assessment of erectile function and urine stream. Results: The age range of the patients was 23-40 years with a median age of 31.5years. The mechanism of injury was vehicular accident (60%) and gunshot (40%). All patients had pelvic fracture. The median distraction defect length was 5 centimeters. None were incontinent. Two patients had erectile dysfunction post operatively which is gradually improving. One patient had a stricture for which he had an optical urethrotomy. Conclusion: Delayed anastomotic urethroplasty for posterior urethral distraction injuries has an acceptable morbidity rate and is useful treatment option for this group of patients.