Traumatic lesions of the posterior urethra

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• 作者：L. Velarde-Ramos^a ; ^{lvelarderamos@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; R. G&oacute ; mez-Illanes^a ; ^b ; F. Campos-Juanatey^c ; J.A. Portillo-Mart&iacute ; n^c ; ^d
• 关键词：PR ; pelvic ring ; SPC ; suprapubic cystostomy ; SVUC ; serial voiding urethral cystography ; BN ; bladder neck ; ED ; erectile dysfunction ; PF ; pelvic fracture ; IIEF ; International Index Erectile Function ; UI ; urinary incontinence ; PFUDD ; pelvic fracture urethral disruption defect ; PFUI ; pelvic fracture urethral injuries ; OPR ; open primary realignment ; EPR ; endoscopic primary realignment ; DU ; deferred urethroplasty ; RUG ; retrograde urethrography ; PU ; posterior urethra
• 刊名：Actas Urológicas Espa?olas (English Edition)
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：40
• 期：9
• 页码：539-548
• 全文大小：1779 K

文摘

The posterior urethral lesions are associated with pelvis fractures in 5–10% of cases. The posterior urethra is attached to the pelvis bone by puboprostatic ligaments and the perineal membrane, which explains why disruption of the pelvic ring can injure the urethra at this level.

Objectives

To identify suspected cases of posterior urethral trauma and to perform the diagnosis and its immediate or deferred management.

Acquisition of evidence

Search in PubMed of articles related to traumatic posterior urethral lesions, written in English or Spanish. We reviewed the relevant publications including literature reviews and chapters from books related to the topic.

Synthesis of the evidence

With patients with pelvis fractures, we must always rule out posterior urethral lesions. The diagnostic examination of choice is retrograde urethrography, which, along with the severity of the condition, will determine the management in the acute phase and whether the treatment will be performed immediately or deferred. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction.

Conclusions

Despite the classical association between posterior urethral lesions and pelvic fractures, the management of those lesions (whether immediate or deferred) remains controversial. Thanks to the growing interest in urethral disease, there are an increasing number of studies that help us achieve better management of these lesions.