Table 5.
Blunt Posterior Urethral Trauma.
| Author | Year | Level of Study | Number of Patients in Study | Diagnostic Procedures | Management | Complications |
|---|---|---|---|---|---|---|
| Dobrowolski ZF, Weglarz W, Jakubik P, et al. [44] | 2002 | 4 | 268 | RUG, voiding cystourethrogram, urethroscopy, spiral CT | Cystostomy + drainage, urethral reconstruction | Procedure: Urethral stricture, urinary tract infection, bleeding, stones, fistula |
| Koraitim MM, Reda IS [13] | 2007 | 4 | 21 | Pre-operative MRI of pelvis to aid in selection of appropriate surgical approach | End-to-end urethral anastomosis | Injury: Retropubic space scarring and fibrosis, fistula, impotence |
| El Darawany HM [37] | 2018 | 4 | 27 | CT Urography, RUG | Initial Management: Suprapubic catheterization to drain bladder Endoscopic urethral realignment |
Procedure: Minimal urethral stricture |
| Koraitim MM [66] | 1996 | 4 | 100 | Clinical examination Excretory urography, retrograde urethrography |
Suprapubic cystostomy indicated for incomplete urethral rupture, slight urethral distraction, and critically unstable patients, and for inadequate facilities or inexperienced surgeons Primary realignment for wide separation of urethral ends or associated injury to bladder neck or rectum |
Procedure: Urethral stricture after suprabpubic cystostomy Impotence and incontinence after primary realignment Impotence and incontinence is greatest after primary suturing |
| Velarde-Ramos L, Gomez-Illanes R, Campos-Juanatey F, et al. [3] | 2016 | 3 | NA | RUG | Primary urethral realignment, delayed urethroplasty, SPC + endoscopic realignment | Procedure: Sepsis, abscess, urinoma |
| Cavalcanti AG, Krambeck R, Araujo A, et al. [67] | 2006 | 3 | 77 | RUG, surgical exploration | Primary urethral realignment/repair | Procedure: Penile curving, corporal body injury |
| Goldman SM, Sandler CM, Corriere JN Jr., et al. [12] | 1997 | 3 | NA | RUG | Delayed urethroplasty | NA |
| Elgammal MA [68] | 2009 | 3 | 53 | RUG | Suprapubic cystostomy, primary urethral realignment | Procedure: Urethral stricture |
| Jordan GH, Virasoro R, Eltahaway EA [9] | 2006 | 3 | NA | Clinical exam: direct examination RUG, cystogram |
SPC + delayed repair, primary urethral realignment, endoscopic realignment | Procedure: Compartment syndrome, rhabdomyolysis |
| Protzel C, Hakenberg OW [57] | 2010 | 3 | NA | Clinical exam: direct examination, digital rectal exam RUG |
Suprapubic urinary diversion + antibiotics, endoscopic transurethral splinting | NA |
| Tezval H, Tezval M, von Klot C, et al. [18] | 2007 | 3 | NA | Clinical exam: Digital rectal exam Suprapubic cystography, RUG, CT scan |
Cystostomy + antibiotics, primary urethral realignment, delayed urethroplasty | Procedure: Stricture, erectile dysfunction, distraction defects, impotence, recurrent stenosis |
| Rosenstein DI, Alsikafi NF [6] | 2006 | 3 | NA | Clinical exam: Digital rectal exam Suprapubic cystography, RUG |
SPC, delayed urethroplasty | Procedure: Bladder rupture, vaginal laceration, rectal tears |
| Luckhoff C, Mitra B, Cameron PA, et al. [8] | 2011 | 3 | 998 | RUG, pelvic X-ray, sonography | Primary urethral realignment | Procedure: Urethral transection |
| Cooperberg M, McAninch JW, Alsikafi NF, et al. [69] | 2007 | 3 | 134 | RUG/ voiding cystourethrogram Pelvic MRI if length of stricture is in question Doppler ultrasound for patients with erectile dysfunction to determine baseline neurological or vascular compromise |
Delayed Anastomotic Posterior Urethroplasty | Procedure: Scrotal hematoma, compartment syndrome (lithotomy position), decubitus ulcer, recurrent stricture |
RUG = retrograde urethrogram, CT = computed tomography, MRI = magnetic resonance imaging.