Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.1050
Peer-review started: June 21, 2021
First decision: July 15, 2021
Revised: July 24, 2021
Accepted: December 22, 2021
Article in press: December 22, 2021
Published online: January 21, 2022
Processing time: 208 Days and 8.9 Hours
A male urethral disruption injury is a urological emergency. Primary endoscopic realignment (PER) refers to reestablishment of urethral alignment via indwelling urethral catheter by cystoscope, which is recommended as the optimal emergent treatment approach for reducing the likelihood of complications following injury. However, the prior literature suggests the success rate of PER to be relatively low due to complicated urethral disruption. We report a modified PER approach that serves to improve both the success rate and safety of the treatment.
A 19-year-old male patient presented with multiple pelvic fractures and complete urethral disruption following a high-velocity traffic accident. The patient’s abdominal computed tomography and retrograde urethrography results revealed complete urethral disruption at the bulbar urethra, with hematoma and contrast medium extravasation that extended into the extraperitoneal space. The conventional retrograde PER by cystoscope failed due to severe disruption and considerable hematoma. Modified simultaneous antegrade and retrograde PER was performed by means of semi-rigid ureteroscopy via a suprapubic Foley catheter and cystoscopy via the external urethra. An antegrade guidewire was passed through the bladder neck and then pulled out through the external urethral meatus with a cystoscope. Urethral continuity was achieved after a 16-Fr silicone Foley catheter was indwelled into the bladder along the guidewire. The patient recovered well, achieving voiding continence and avoiding further operation for urethral stricture.
Modified PER via suprapubic Foley catheter represents a promising and safe treatment approach in patients with posterior urethral injuries.
Core Tip: We report a modified primary endoscopic realignment to improve both the success rate and intraoperative safety of a patient with high-grade urethral disruption injury. The surgery was performed with simultaneous antegrade and retrograde endoscopes. We used a suprapubic Foley catheter to serve as an access route of the antegrade cystoscope. The antegrade guidewire was passed through the bladder neck and pulled out through the external urethra, with assistance of the retrograde cystoscope. For the 19-year-old male who presented with high-grade complete urethral disruption after traffic accident, modified endoscope realignment was achieved, and the patient recovered well.