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Primary endoscopic realignment

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Primary endoscopic realignment

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Primary endoscopic realignment

  1. 1. URETHRAL INJURY & PRIMARY ENDOSCOPIC REALIGNMENT Dr. Eko Indra Pradono Urology Division Department of Surgery Adam Malik General Hospital - Indonesia
  2. 2. AETIOLOGY OF URETHRAL INJURY
  3. 3. CLINICAL SIGNS • Meatal Bleeding • In ability to void • Haematuria • Pain on urination • Urinary Extravasation & Bleeding in Scrotal, Penile, &Perineal Swelling • Ecchymosis • DRE  ‘High Riding’ Prostate • Inability to pass urethral catheter TRIAD Urethral disruption : blood at the meatus, inability to urinate, and palpably full bladder.
  4. 4. DIAGNOSTIC EVALUATION • Retrogade urethrography • Cystoscopy
  5. 5. Management of Anterior Urethral Injuries in Men Kitrey ND, Djakovic N, Gonsalver M, et al. EAU Guidelines on Urological Trauma. EAU. 2017
  6. 6. Management of posterior urethral injury: • Primary surgical repair • Puprapubic cystostomy with delayed urethroplasty • Primary endoscopic realignment of the urethral end
  7. 7. POSTERIOR URETHRAL INJURY The timing of the surgical intervention : – Immediate : < 48 hours after injury; – Delayed primary : two days to two weeks after injury; – Deferred : > three months after injury. Kitrey ND, Djakovic N, Gonsalver M, et al. EAU Guidelines on Urological
  8. 8. Management of posterior urethral injuries in men Kitrey ND, Djakovic N, Gonsalver M, et al. EAU Guidelines on Urological Trauma. EAU. 2017
  9. 9. Primary Endoscopic Realignment • Ormond and Cothran first described in 1934 • The aim is to correct severe distraction injuries rather than to prevent a stricture • Traditionally, urethral injury is managed with an initial suprapubic cystostomy and urethral reconstruction 3 – 6 months after. • Endoscopic re-alignment is the preferred technique.
  10. 10. Endoscopic Realignment Benefits : – a lower stricture rate – if scarring and subsequent stricture formation occurs, the restoration is simplified; – for short strictures (< 2 cm), non-obliterative strictures  internal urethrotomy – for longer strictures, or in the case of failure of an internal urethrotomy  urethroplasty – if urethroplasty is required later, it is technically easier when the prostate and urethra are well aligned Kitrey ND, Djakovic N, Gonsalver M, et al. EAU Guidelines on Urological Trauma. EAU. 2017
  11. 11. Endoscopic Realignment Technique : •Using a flexible/rigid cystoscope and biplanar fluoroscopy, a guidewire is placed inside the bladder  a catheter is placed into the bladder •If necessary, two cystoscopes can be used : retrograde and antegradely •The duration of catheter stay varies between four and eight weeks among series Kitrey ND, Djakovic N, Gonsalver M, et al. EAU Guidelines on
  12. 12. Conclusion •Primary Endoscopic realignment may have minimal effect of complication because of lack of manipulation of surrounding neurovascular bundles.
  13. 13. THANK YOU
  14. 14. Thank You

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