title: [Causes and salvage of failed urethroplasties for traumatic urethral injury].
abstract: OBJECTIVE
  Salvage urethroplasty after failed repair of traumatic urethral injury is a urological challenge, and we herein describe our experience with it.
  
  
  METHODS
  From October 2010 to January 2012, five patients underwent salvage repair of failed urethroplasties for traumatic urethral injuries: three bulbar straddle injuries and two pelvic fracture urethral injuries. One of the three failed urethroplasties for bulbar straddle injuries was a stricture excision and primary anastomosis, and its failure was due to periurethral abscess formation. Another was an augmented anastomotic urethroplasty using buccal mucosa, and its failure was due to periurethral abscess formation. The third was a tube graft urethroplasty using buccal mucosa, and its failure was due to a stricture at the anastomotic site. Two failed urethroplasties for pelvic fracture urethral injuries were perineal anastomotic repairs combined with corporal separation and inferior pubectomy, and the failures of both were due to ischemic bulbar necrosis. The urethral gap lengths estimated from urethrograms ranged from 12 to 45 mm (mean = 26 mm).
  
  
  RESULTS
  Urethroplasties in all patients with bulbar straddle injuries were salvaged by stricture excision and primary anastomosis with corporal separation, and urethroplasties in both patients with pelvic fracture urethral injuries were salvaged by abdominal transpubic perineal urethroplasty. Although the patients who underwent transpubic urethroplasty had transient pelvic girdle pain, no severe complications were observed. All patients were for 10 to 25 months postoperatively (mean = 16 months) able to void satisfactorily without additional treatment.
  
  
  CONCLUSIONS
  Failed urethroplasties for traumatic urethral injuries can be salvaged with a second reconstruction surgery. The procedure of choice for this salvage is anastomotic urethroplasty with techniques for tension-free anastomosis.
authors: Department of Urology, National Defense Medical College, Saitama, Japan.
authors: Akio
authors: A
authors: Horiguchi
authors: Ryuichi
authors: R
authors: Azuma
authors: Shinsuke
authors: S
authors: Tasaki
authors: Shinsuke
authors: S
authors: Hamada
authors: Kenji
authors: K
authors: Kuroda
authors: Akinori
authors: A
authors: Sato
authors: Junichi
authors: J
authors: Asakuma
authors: Kenji
authors: K
authors: Seguchi
authors: Masamichi
authors: M
authors: Hayakawa
authors: Keiichi
authors: K
authors: Ito
authors: Tomohiko
authors: T
authors: Asano
mesh_terms: D000293:Adolescent; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D016879:Salvage Therapy; D016896:Treatment Outcome; D014521:Urethra / Q000293:injuries* / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology