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Urethroplasty for urethral trauma Introduction: Urethral injuries are usually part of multiple injuries associated with motor vehicle and industrial accidents. They are difficult to manage and continue to challenge the urologist and health care facilities. Objective: To highlight the complexity of urethral injuries and to emphasise their prevention. Materials and methods: Eighteen patients with urethral injuries were operated upon by the authors between 1997 and 2005. Thirteen of the injuries involved the membranous urethra and five the bulbar urethra. The mechanism of injury was pelvic fracture in eleven, gunshot in one, fall onto a sharp object in one, animal injury in one and astride injuries in four. Operative repairs were: anastomotic urethroplasty in sixteen and sutureless membranous urethroplasty in two. One failure of sutureless membranous urethroplasty who was also totally impotent after the injury was subjected to appendicovesicon (Mitrofanoff procedure). Results: Thirteen of the sixteen patients who had anastomotic urethroplasty had completed recovery. Three required bouginage, of whom two were started on clean intermittent self-catheterisation. One of these had complete restenosis and was referred to a visiting team. The patient with successful membranous urethroplasty developed a stricture a year later, had optical urethrotomy done and started on clean intermittent self-catheterisation. The patient with a Mitrofanoff stoma remains continent with no urinary calculi, eight years after the surgery. Conclusion: Urethral injuries present difficult surgical challenges. Surgeons are encouraged to master the various reconstruction techniques. Emphasis in on prevention of these injuries by appropriate road, industrial and occupational safety measures. |
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