Reconstruction of Pelvic Fracture Urethral Injuries With Sparing of the Bulbar Arteries.

OBJECTIVE

To present a novel reconstruction technique for patients with pelvic fracture urethral injuries (PFUI) with bulbar artery sparing.

MATERIALS AND METHODS

We modified the traditional technique for PFUI reconstruction to preserve the proximal arterial inflow to the bulb. Since 2008, 26 consecutive patients have undergone this technique at our institution. The bulbar arteries are located using a Doppler ultrasound stethoscope and then the bulb is mobilized from one side only, without detachment from the perineum. The artery from that side is sacrificed to preserve the contralateral one; sometimes both arteries can be spared. Removal of the scar and end-to-end anastomosis is performed as usual. Successful arterial preservation was verified by postanastomosis Doppler auscultation.

RESULTS

Mean age was 37 years (15 to 70). Median time from trauma to urethral reconstruction was 11 weeks and mean stenosis length was 2.3 cm (1 to 4.5 cm). The left bulbar artery was preserved in 14 cases, the right in 4, and both arteries were spared in seven; an accidental injury of the artery to be preserved occurred in the remaining case. At a mean follow-up of 20 months (2-69), all patients are voiding normally stricture free.

CONCLUSION

Preservation of proximal arterial blood supply to the bulb during PFUI reconstruction is feasible and safe. A well-perfused reconstruction should heal better and theoretically our technique may avoid ischemic failure of the urethroplasty. A larger series and replication of our results in other centers are necessary to validate our technique's potential benefits.