Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 21, 2022; 10(3): 1050-1055
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.1050
Novel method of primary endoscopic realignment for high-grade posterior urethral injuries: A case report
Cheng-Ju Ho, Min-Hsin Yang
Cheng-Ju Ho, Min-Hsin Yang, Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Cheng-Ju Ho, Min-Hsin Yang, Department of Urology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
Author contributions: Ho CJ and Yang MH designed the report, collected the patient’s clinical data, analyzed the data, and wrote the paper.
Informed consent statement: Consent was obtained from the patient for treatment and publication of his anonymized case data and accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
Corresponding author: Min-Hsin Yang, MD, Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., Taichung 40201, Taiwan. barbarian06070136@gmail.com
Received: June 21, 2021
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

Modified PER via suprapubic Foley catheter represents a promising and safe treatment approach in patients with posterior urethral injuries.

Keywords: Posterior urethral injury, Emergent treatment, Primary endoscopic realignment, Novel method, Case report

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.