title: Perineal repair of pelvic fracture urethral injury: in pursuit of a successful outcome.
abstract: OBJECTIVE
  To determine perioperative factors that may optimize the outcome after delayed perineal repair of a pelvic fracture urethral injury (PFUI).
  
  
  METHODS
  In all, 86 consecutive patients who underwent perineal repair of a PFUI between 2004 and 2011 were prospectively enrolled in this study. The mean (range) patient age was 23 (5-50) years. The mean (range) follow-up was 5.5 (2-8) years. We examined seven perioperative variables that might influence the outcome including: prior failed treatment, condition of the bulbar urethra, displacement of the prostate, excision of scarred tissues, fixation of the mucosae of the two urethral ends, and the number and size of sutures used for urethral anastomosis. Univariate and multivariate analyses were used to identify factors that influence postoperative outcome.
  
  
  RESULTS
  Of the patients, 76 (88%) had successful outcomes and 10 (12%) were considered treatment failures. On univariate analysis, four variables were significant factors influencing the outcome: excision of scarred tissues, prostatic displacement, condition of the bulbar urethra and fixation of the mucosae. On multivariate analysis only two remained strong and independent factors namely complete excision of scarred tissues and prostatic displacement in a lateral direction.
  
  
  CONCLUSIONS
  Meticulous and complete excision of scar tissue is critically important to optimise the outcome after perineal urethroplasty. This is particularly emphasised in cases associated with lateral prostatic displacement. Six sutures of 3/0 or 4/0 polyglactin 910 are usually sufficient to create a sound urethral anastomosis. Prior treatment and scarring of the anterior urethra do not affect the outcome.
authors.affiliation: Department of Urology, College of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Mamdouh M
authors.initials: MM
authors.lastname: Koraitim
authors.affiliation: Department of Occupational and Enviromental Medicine, College of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Mohamed I
authors.initials: MI
authors.lastname: Kamel
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008875:Middle Aged; D010384:Pelvic Bones / Q000601:surgery*; D010502:Perineum / Q000601:surgery; D011446:Prospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000293:injuries* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D055815:Young Adult
keywords: outcome; pelvic fracture; perineal repair; urethral injury