title: Laparoscopic omentoplasty to support anastomotic urethroplasty in complex and redo pelvic fracture urethral defects.
abstract: OBJECTIVE
  To test the hypothesis that a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex and prior failed pelvic fracture urethral defect repair was feasible, safe, and effective.
  
  
  METHODS
  We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approach for urethroplasty in patients with pelvic fracture urethral defect at a single center in Pune, India, between January 2012 and February 2013. Complex and redo patients with pelvic fracture urethral defect occurring after pelvic fracture urethral injury were included in the study. Anterior urethral strictures were excluded. The primary study outcome was the success rate of the surgical technique, and the secondary outcome was to evaluate feasibility and safety of the procedure. The clinical outcome was considered a failure when any postoperative instrumentation was needed.
  
  
  RESULTS
  Fifteen male patients with a median age of 19 years were included in the study. Seven patients were adolescents (12-18 years) and 8 patients (53.3%) were adults (19-49 years). The mean number of prior urethroplasties was 1.8 (range, 1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to envelope the anastomosis and to fill the perineal dead space. Of 15 patients, 14 (93.3%) were successful and 1 (6.6%) failed. One adolescent boy 14 years old developed a recurrent stricture 2 months after the procedure and was managed using internal urethrotomy. Median follow-up was 18 months (range, 13-24 months).
  
  
  CONCLUSIONS
  Combining a laparoscopic omentoplasty to a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is successful, feasible, safe, and with minimal additional morbidity to the patient. The technique has the advantage of a perineal incision and the ability to use the omentum to support the anastomosis.
authors.affiliation: Kulkarni Reconstructive Urology Center, Pune, India. Electronic address: sanjaybkulkarni@gmail.com.
authors.forename: Sanjay B
authors.initials: SB
authors.lastname: Kulkarni
authors.affiliation: Center for Reconstructive Urethral Surgery, Centro Chirurgico Toscano, Arezzo, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Barbagli
authors.affiliation: Kulkarni Reconstructive Urology Center, Pune, India.
authors.forename: Pankaj M
authors.initials: PM
authors.lastname: Joshi
authors.affiliation: Kulkarni Reconstructive Urology Center, Pune, India.
authors.forename: Craig
authors.initials: C
authors.lastname: Hunter
authors.affiliation: Kulkarni Reconstructive Urology Center, Pune, India.
authors.forename: Walid
authors.initials: W
authors.lastname: Shahrour
authors.affiliation: Kulkarni Reconstructive Urology Center, Pune, India.
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Kulkarni
authors.affiliation: Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sansalone
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D000714:Anastomosis, Surgical; D050723:Fractures, Bone / Q000150:complications; D010535:Laparoscopy; D009852:Omentum / Q000601:surgery; D010384:Pelvic Bones / Q000293:injuries; D011446:Prospective Studies; D014521:Urethra / Q000293:injuries / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods