[Resection-suture of the posterior urethra for post-traumatic stenosis. Study of 29 patients operated upon between 1964 and 1976].
The authors report their experience of resection-suture of post-traumatic stenoses of the posterior urethra. Their series includes 27 patients suffering pelvic or perineal trauma (26 fractures, including 12 severe with crushing of the pelvis or symphisieal dysjunction). In 9 cases there had been an attempt at emergency repair of the urethral rupture via a perineal approach and in 5 a secondary local repair (4 urethral resection-sutures and 1 insertion of an arterial graft). Twelve patients in this series had additional lesions : 5 false channels, 3 urethroperineal fistulae, 3 urethrorectal fistulae and one periprostatic leak. The authors emphasise the principles which guided their technique : total excision of fibrous callus, excision of the entire length of pathological urethra including the membranous urethra and the prostatic apex if necessary, sufficient mobilisation of healthy zones to permit urethral suture without traction (dissection of the lower end of the prostatic urethra separated from the pubis and rectum, extensive dissection of the spongious urethra, separation of the corpora cavernosa.) Suture using non-absorbable material. Drainage of urine via an indwelling urethral catheter for 12 to 20 days. The postoperative period of follow up is longer than 1 year in 22 patients, more than 2 years in 20 and 4 years in 19. In the latter 19, results were perfect for 16 (87%) and fairly good in two. No late failures! Four of the patients had to undergo a number of secondary urethral dilatations but these dilatations could be completely stopped in three of them without any subsequent worsening. No case of persistent sexual impotence imputable to urethral resection-suture, since problems of virility recovered in periods of 4 to 18 months.
D000293:Adolescent; D000328:Adult; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000293:injuries; D010502:Perineum / Q000293:injuries; D012421:Rupture; D014521:Urethra / Q000293:injuries* / Q000601:surgery; D014522:Urethral Diseases / Q000601:surgery; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*; D014947:Wounds and Injuries / Q000150:complications
Résection-suture de l'urètre postérieur pour sténose post-traumatique. Etude de 29 malades opérés de 1964 à 1976.