Straddle Injuries to the Bulbar Urethra : Management and Outcome in 53 Patients

Objective: To describe our experience with blunt injuries to the bulbar urethra and their late sequelae to identify factors that may affect patient outcome. Materials and Methods: A retrospective study was performed on 53 male patients who presented, between January 2001 Results: Conclusions: strictures that develop after straddle injury to the bulbar urethra.


INTRODUCTION
terior urethral injuries.Blunt injuries are more com bile pendulous urethra.Blunt injuries to the bulbar urethra are typically caused by straddle type injuries

Clinical Urology Clinical Urology
(2). tions after blunt trauma to the bulbar urethra remains the literature is whether it is better to divert the urine whether strictures that develop after straddle injury to or endoscopic urethrotomy.
Because only a few small series have been of these injuries.

MATERIALS AND METHODS
A retrospective study was carried out on 53 male patients who presented to our trauma unit be tween January 2001 and December 2005 with blunt traumatic injury of the bulbar urethra.No attempts extravasation of contrast medium in the area of the ance of contrast extravasation in the area of the bulbar biotics at induction of anesthesia.Either suprapubic injected into the catheter to verify its position inside could urinate freely, they were removed.If patients respectively.In cases of complete urethral injury with perineal hematoma or extravasation, no attempt raphy.

Patient Characteristics
years).The mechanism of injury was a fall astride in urethral contusion alone.

Partial Urethral Disruption
Of the 31 patients with partial urethral rup cystostomy, and stricture formation occurred in 2 tients treated primarily with suprapubic cystostomy was not statistically different from those treated pri all of these patients were treated successfully with

Complete Urethral Disruption
Of the 22 patients with complete urethral prapubic cystostomy, stricture formation occurred in ment, and stricture formation occurred in all patients removal.The duration of stricture formation was not patients treated primarily with suprapubic cystostomy VIU and 3 patients with impassable stricture after injury were treated with anastomotic urethroplasty, The incidence of stricture formation after complete

Primary Management
tients characteristics between those treated primarily with suprapubic cystostomy and those treated with suprapubic cystostomy, stricture formation occurred

COMMENTS
typically entails suprapubic urinary diversion or effectively by VIU ( 5).In the present study, stricture that excellent results could be obtained with urinary repair of the urethra achieved a better outcome (3).However, the type of trauma in the study by Husmann all patients had blunt trauma.
In the recent review of straddle injuries to between the present study and the series reported by stricture formation only in patients who presented acutely after urethral injury and excluded patients who presented late after trauma without previous urinary terior urethral avulsion injuries, it could be expected eter in anterior urethral injury should produce fewer commonly required urethroplasty than the suprapubic required.In the current study, stricture formation de Also, the strictures that developed after suprapubic than the strictures that developed after urethral re It is possible that with early suprapubic cystostomy for total or partial urethral disruption the would be limited and the severity of stricture forma catheter in the area of urethral injury may cause a may cause additional injury to the ruptured urethra.
sive methods has become a common contemporary posterior urethral disruptions and the stricture rates

Table 1 -
Stricture formation in relation to type of urethral injury and primary treatment.

Table 2 -
Patient characteristics in relation to primary treatment.

Table 3 -
Outcomes after urethroplasty and visual internal urethrotomy (VIU).The limitations of this study are that it is not CONCLUSION is associated with a lower recurrence rate than VIU injury to the bulbar urethra.catheter is in place, it serves to stent open the bladder tion cannot be completely answered.However, the question the need for heroic attempts at endoscopic in terms of future stricture rates are at least similar and