CU 44. Partial inferior pubectomy combined with the abdominal- perineal approach in management of posttraumatic complex posterior urethral distraction defects

Summary: Surgical repair of post-traumatic complex posterior urethral distraction defects remains one of the most challenging problems in urology.

Objective: To show that partial inferior pubectomy combined with the abdominal-perineal approach is an alternative in the management of post-traumatic complex posterior urethral distraction defects.

Design: Retrospective case series.

Interventions: 9 patients who had treatment failure in previous attempts of transperineal repair of post-traumatic posterior urethral distraction defects from January 2003 to September 2006. Partial inferior pubectomy combined with the abdominal-perineal approach was used in all patients. The median operating time was 301 minutes and the median hospital stay was 13 days. All patients were followed up for 18 months. Follow-up evaluations included voiding, urethrography, and uroflowmetry, which were carried out postoperatively at 3, 6, 12, and 18 months.

Results: Seven patients had successful outcomes as demonstrated by satisfactory uroflowmetry (median Q_max: 15 mL/s), urethrography, and subjective improvement in the voiding pattern. One patient developed slight urethral stricture and one patient had the problem of hair in the urethra that was successfully managed by a second surgery. Partial inferior pubectomy combined with the abdominal-perineal approach is a good alternative for repair of post-traumatic complex posterior urethral distraction defects. It is safe and has the advantage of better visualization of the apex of the prostate and the surgical field, and may shorten the length of the reconstructed urethra, with subsequent good outcomes, without immediate or remote effects on the stability of the pelvis or bladder.