title: Predictors for success of internal urethrotomy in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries.
abstract: BACKGROUND
  Internal urethrotomy (IU) in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries (PRPFUI) is troublesome. We evaluated the clinical factors affecting the surgical outcome of IU for urethral contracture after PRPFUI.
  
  
  METHODS
  We retrospectively reviewed the records of 35 patients who underwent IU for urethral contracture after PRPFUI between March 2004 and June 2013. Ages of patients ranged from 18 to 50, and their follow-up duration was more than 1year after IU. The urethral contracture was confirmed by retrograde urethrogram or cysto-urethroscopy. Success was defined as greater than 15mL/s of peak urinary flow rate at 1year after IU without any clinical evidence of urethral contracture. Success rates were investigated according to the number of IU. Age, body mass index, urethral defect length before PRPFUI, time interval between the original urethral injury and the PRPFUI or between a previous operation and the PRPFUI, time interval between the PRPFUI and the urethral contracture, number of PRPFUI performed, and the type of urethral lengthening procedure were compared between patients with and without success according to the number of IU.
  
  
  RESULTS
  Among the 35 patients, the overall success rate of IU was 37% (13/35) during the mean follow-up period of 53 months (range: 17-148 months). There were 8 and 5 patients with success in first and second IU, respectively. However, there was no success after third IU. Urethral defect length before PRPFUI was significantly shorter in patients with success who underwent first and second IU (p<0.05). There were significant differences of success between patients with and without previous repeated failures of PRPFUI in first and second IU (p<0.05).
  
  
  CONCLUSIONS
  Short urethral defect length and no previous surgical failures before PRPFUI are good prognostic factors for IU following PRPFUI. Only one or two IUs will be helpful in patients with urethral contracture following PRPFUI.
authors.affiliation: Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea. Electronic address: urohong@chamc.co.kr.
authors.forename: Young-Kwon
authors.initials: YK
authors.lastname: Hong
authors.affiliation: Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea. Electronic address: khchoi@cha.ac.kr.
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Choi
authors.affiliation: Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea. Electronic address: ytleeuro@cha.ac.kr.
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Lee
authors.affiliation: Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea. Electronic address: seung102@cha.ac.kr.
authors.forename: Seung-Ryeol
authors.initials: SR
authors.lastname: Lee
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D003286:Contracture / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D010502:Perineum / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D014521:Urethra / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014522:Urethral Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D014567:Urography; D055815:Young Adult
keywords: Pelvic fracture; Urethra; Urethral contracture; Urethroplasty; Urethrotomy