PROGRESSIVE PERINEAL URETHROPLASTY

A 30 year old gentleman came with pelvic fracture and urethral distraction defect(PFUDD).

We usually do in such cases combined RGU and MCU with alpha blockers starting one day prior.The alpha blocker will open the bladder neck and we will have a faint idea of post urethral anatomy and the extent of the defect between the proximal bulb and the prostatic urethra.

We took him for progressive perineal urethroplasty.The midline perineal incision was taken and the urethra was dissected till the stricture.The bulbar urethra was cut at the healthy margins and the proximal dissection into the prostatic urethra was started.

The Haygrove staff was introduced form SPC and the dissection was done around the distal end of the staff felt in the prostatic margin.

The prostatic uretha was opened and trimmed till helath margins are exposed.Stay sutures were taken to the prostatic urethral margins.Bulboprostaic anastomosis was done with 6 (4-0 vicryl )sutures.

BULBAR URETHRA CUT AT THE HEALTHY MARGIN

THE DISTAL URETHA WAS MOBILISEDE BY CUTTING THE TRAINGULAR LIGAMNET AND SEPARATING THE CRUS

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BULBOPROSTATIC ANASTOMOSIS

Litearature of PFUDD and progressive perineal urethroplasty

Traditionally, it has been accepted that urethral rupture in men occurs at the prostatomembranous junction by the shearing forces that avulse the prostatic apex from the urogenital diaphragm. 

Posterior urethral injuries often take a low priority in the management of patients with pelvic fracture injuries as these individuals almost always have multiple injuries of more serious consequence. Most patients are best treated by a suprapubic catheter initially followed 3 months later by an end-to-end anastomotic urethroplasty in those who have developed urethral occlusions. Although there are roles for delayed primary repair and for endourologic management in selected patients, their exact roles have yet to be defined.

Traditionally a progressive perineal urethroplasty is performed after 3 months after the trauma.