title: Redo-urethroplasty in pelvic fracture urethral distraction defect: an audit.
abstract: OBJECTIVE
  To predict the outcome of redo-urethroplasty after failed single or multiple open urethral procedures for pelvic fracture urethral distraction defects.
  
  
  METHODS
  From January 1997 to December 2006, 43 patients underwent redo-urethroplasty for pelvic fracture urethral distraction defect. Forty-one were referred from other centers. All had undergone open surgery along with an endoscopic procedure (one or more procedures in each patient) which included endoscopic internal urethrotomy, urethral stenting or urethral dilations.
  
  
  RESULTS
  There were 43 men with mean age of 29 (range 11-52). Eleven had associated injuries: intraperitoneal bladder rupture (3), bladder neck (2), rectum (3), anal sphincter (2), combined bladder, rectum and anal sphincter (1). Trocar suprapubic cystostomy was performed in 22, rail-road procedures in 10 and open suprapubic cystostomy in 11 along with the management of associated injuries as immediate treatment. Of 43 patients, 28 had progressive perineal, and 12 had transpubic repair. Three patients had total bulbar necrosis, and they underwent prepuceal tube reconstruction (1) and staged substitution with BMG and standard scrotal inlay (2). Analysis of various factors like number of attempts at previous surgery and stricture length did not affect the outcome. A successful result was achieved in 36 (83.72%), improved and stable in five and failure in two.
  
  
  CONCLUSIONS
  The overall result of redo-urethroplasty for pelvic fracture urethral distraction defect continues to be gratifying. Failures happen usually within the first 3 months. Substitution urethroplasty can be reserved for those who have long distraction defect. Long-term follow-up is essential using stringent criteria to measure success.
authors.affiliation: Department of Urology, Christian Medical College, Vellore, 632004, India.
authors.forename: Suresh K
authors.initials: SK
authors.lastname: Bhagat
authors.forename: Ganesh
authors.initials: G
authors.lastname: Gopalakrishnan
authors.forename: Santosh
authors.initials: S
authors.lastname: Kumar
authors.forename: Antony
authors.initials: A
authors.lastname: Devasia
authors.forename: Nitin S
authors.initials: NS
authors.lastname: Kekre
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000293:injuries / Q000601:surgery; D002648:Child; D054869:Clinical Audit; D003125:Colostomy; D003559:Cystostomy; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D012007:Rectum / Q000293:injuries / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000293:injuries* / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery; D001743:Urinary Bladder / Q000293:injuries / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult