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George D Webster - One of the best experts on this subject based on the ideXlab platform.

  • female urethral injuries associated with Pelvic Fracture a systematic review of the literature
    BJUI, 2017
    Co-Authors: Devin Patel, George D Webster, Jennifer T Anger
    Abstract:

    Objectives To systematically review the literature of female urethral injuries associated with Pelvic Fracture and determine optimal management of this rare injury. Materials and Methods Using Meta-analysis Of Observational Studies in Epidemiology criteria, we searched Cochrane, Pubmed and OVID databases for all articles available before June 30, 2016 using the terms “female Pelvic Fracture urethroplasty,” “female urethral distraction,” “female Pelvic Fracture urethral injury,” “female Pelvic Fracture urethra girls.” Two reviewers (CF, DP) independently reviewed the titles, abstracts, and articles in duplicate. Results We identified 162 individual articles from the databases. Fifty-one articles met our criteria for full review. There were 158 female patients with urethral trauma. Of these injuries, 83 (53%) were managed with immediate repair, with 17/83 (20%) via primary alignment and 66/83 (80%) via anastomotic repair. The remaining 75/158 (47%) were managed with delayed repair. Rates of urethral stenosis and fistula were highest after primary alignment. Urethral integrity appears to be similar following both primary anastomosis and delayed repair; however, patients experienced significantly more incontinence and vaginal stenosis following delayed repair. Those patients who underwent delayed urethral repair were more likely to undergo more extensive reconstructive surgery than those who underwent primary repair. Conclusions The optimal management of female urethral distraction defects is based on very low quality literature. Based on our review of the available literature, primary anastomotic repair of a female urethral distraction defect via a vaginal approach as soon as the patient is hemodynamically stable appears optimal. This article is protected by copyright. All rights reserved.

  • erectile function after posterior urethroplasty for Pelvic Fracture urethral distraction defect injuries
    BJUI, 2009
    Co-Authors: Jennifer T Anger, Neil D Sherman, Elodi Dielubanza, George D Webster
    Abstract:

    OBJECTIVE To determine the specific effect of Pelvic Fracture-urethral distraction defect (PFUDD) injuries on erectile function (EF) in men after Pelvic Fractures, and to compare EF to that found in other studies of men who sustained Pelvic Fractures, as currently the relationship between erectile dysfunction (ED) and PFUDD has not been elucidated using validated questionnaires. PATIENTS AND METHODS With approval from the institutional review board, patients who sustained a PFUDD injury and had a posterior urethroplasty from 1990 to 2004 were identified from a database. Patients were contacted by telephone, and those who were willing to participate were given the International Index of Erectile Function (IIEF) questionnaire. Using unpaired Student’s t-tests, IIEF scores were compared to normal controls, and to results of other studies of men sustaining Pelvic Fractures. RESULTS In all, 26 men completed the IIEF, among whom EF was compromised in 14 (54%), including eight with severe ED (31%). Orgasmic function and ejaculation was maintained. Men with a PFUDD had significantly worse EF than men in other series with Pelvic Fractures. CONCLUSIONS Men who sustain a PFUDD are at significantly greater risk of ED than those with no urethral distraction injury. Men with PFUDD injuries represent a target population for early penile rehabilitation programmes.

  • perineal repair of Pelvic Fracture urethral distraction defects experience in 120 patients during the last 10 years
    The Journal of Urology, 2003
    Co-Authors: Brian J Flynn, Fernando C Delvecchio, George D Webster
    Abstract:

    ABSTRACTPurpose: We report the long-term success of a 1-stage perineal anastomotic repair in patients with Pelvic Fracture urethral distraction defects.Materials and Methods: A retrospective analysis of 120 patients undergoing perineal bulboprostatic anastomotic repair of Pelvic Fracture urethral distraction defect in a single stage using our progressive approach between May 1991 and May 2001 was performed. Patients with posterior urethral stricture due to other etiologies, or those who underwent substitution urethroplasty or abdominoperineal repair were excluded from this review. Preoperative evaluation of the urethral defect included simultaneous retrograde urethrogram and voiding cystourethrogram. Postoperative retrograde urethrogram was performed at 3 weeks, 3 months, 12 to 18 months and as indicated thereafter.Results: Mean patient age was 32 (range 6 to 82) years. The estimated preoperative radiographic length of the distraction defect was 3.1 cm (range 0.5 to 10). Mean followup was 64 (range 9 to 1...

  • the significance of the open bladder neck associated with Pelvic Fracture urethral distraction defects
    The Journal of Urology, 1999
    Co-Authors: George D Webster, Christophe E Iselin
    Abstract:

    AbstractPurpose: As a result of Pelvic Fracture urethral distraction defects, urinary continence relies predominantly on intact bladder neck function. Hence, when cystoscopy and/or cystography reveals an open bladder neck before urethroplasty, the probability of postoperative urinary incontinence may be significant. Unresolved issues are the necessity, the timing and the type of bladder neck repair. We report the outcome of various therapeutic options in patients with Pelvic Fracture urethral distraction defects and open bladder neck. We also attempt to identify prognostic factors of incontinence before urethroplasty.Materials and Methods: We retrospectively reviewed the records of 15 patients with a mean age of 30 years in whom an open bladder neck was identified before posterior urethroplasty between January 1981 and October 1997.Results: Of the 15 patients 6 were continent and 8 were incontinent postoperatively. One patient underwent artificial urethral sphincter implantation simultaneously with Pelvic...

  • impotence following Pelvic Fracture urethral injury incidence aetiology and management
    BJUI, 1995
    Co-Authors: Stephen D Mark, T E Keane, R M Vandemark, George D Webster
    Abstract:

    Objective To evaluate the potency status of patients undergoing delayed perineal repair following a Pelvic Fracture urethral injury to determine the incidence and aetiology of impotence. Patients and methods Long-term potency (> 6 months post-operatively) was subjectively evaluated in 92 patients and correlated with their pre-operative and intra-operative findings. The management of their impotence was also reviewed. Thirty original Pelvic radiographs were assessed independently to determine if the pattern of bony injury was associated with the development of impotence. Results Fifty-seven patients (62%) remained impotent in the long term with a median follow-up of 48 months (range 12–128) and the operation did not render any potent patient impotent. Self-injection with vasoactive agents was successful in 24 of 27 (89%), suggesting a neurogenic aetiology in the majority. Bilateral pubic rami Fracture was also associated with a high incidence of impotence. Conclusion Disruption of the cavernosal nerves lateral to the prostatomembranous urethra behind the sym-physis pubis is the most likely cause of impotence in this injury.

Hunter Wessells - One of the best experts on this subject based on the ideXlab platform.

  • the incidence of erectile dysfunction after Pelvic Fracture urethral injury a systematic review and meta analysis
    Arab journal of urology, 2015
    Co-Authors: Sarah D Blaschko, Hunter Wessells, Melissa T Sanford, Bruce J Schlomer, Amjad Alwaal, Glen Yang, Jacqueline Villalta, Jack W Mcaninch, Benjamin N Breyer
    Abstract:

    BACKGROUND:Pelvic Fracture urethral injury (PFUI) is associated with a high risk of erectile dysfunction (ED). The effect of the type of posterior urethral disruption repair on erectile function has not been clearly established. We systematically reviewed and conducted a meta-analysis of the proportion of patients with ED at (i) baseline after Pelvic Fracture with PFUI, (ii) after immediate primary realignment, and (iii) after delayed urethroplasty. METHODS:Using search terms for primary realignment or urethroplasty and urethral disruption, we systematically reviewed PubMed and EMBASE. A meta-analysis of the proportion of patients with ED was conducted assuming a random-effects model. RESULTS:Of 734 articles found, 24 met the inclusion criteria. The estimate of the proportion (95% confidence interval) of patients with ED after (i) PFUI was 34 (25-45)%, after (ii) immediate primary realignment was 16 (8-26)%, and after (iii) delayed urethroplasty was an additional 3 (2-5)% more than the 34% after Pelvic Fracture in this cohort. CONCLUSIONS:After Pelvic Fracture, 34% of patients had ED. After primary endoscopic alignment, patients had a lower reported rate of ED (16%). Delayed urethroplasty conferred an additional 3% risk above the 34% associated with PFUI alone, with 37% of patients having de novo ED. The difference in de novo ED after primary endoscopic alignment vs. delayed urethroplasty is probably due to reporting differences in ED and/or patients with less severe injury undergoing primary realignment.

  • primary realignment of Pelvic Fracture urethral injuries
    Urologic Clinics of North America, 2013
    Co-Authors: Laura Leddy, Bryan B Voelzke, Hunter Wessells
    Abstract:

    : This article reviews the history, indications, technique, complications, and outcomes of primary urethral realignment of Pelvic Fracture urethral injuries. In clinically stable patients, an attempt at endoscopic urethral realignment is appropriate and may result in long-term urethral patency. However, long term follow up is necessary due to elevated rates of delayed stricture formation requiring endoscopic or surgical repair.

  • outcomes of endoscopic realignment of Pelvic Fracture associated urethral injuries at a level 1 trauma center
    The Journal of Urology, 2012
    Co-Authors: Laura Leddy, Hunter Wessells, Alex J Vanni, Bryan B Voelzke
    Abstract:

    Purpose: We examined the success of early endoscopic realignment of Pelvic Fracture associated urethral injury after blunt Pelvic trauma.Materials and Methods: A retrospective review was performed of patients with Pelvic Fracture associated urethral injury who underwent early endoscopic realignment using a retrograde or retrograde/antegrade approach from 2004 to 2010 at a Level 1 trauma center. Followup consisted of uroflowmetry, post-void residual and cystoscopic evaluation. Failure of early endoscopic realignment was defined as patients requiring urethral dilation, direct vision internal urethrotomy, posterior urethroplasty or self-catheterization after initial urethral catheter removal.Results: A total of 19 consecutive patients (mean age 38 years) with blunt Pelvic Fracture associated urethral injury underwent early endoscopic realignment. Twelve cases of complete urethral disruption, 4 of incomplete disruption and 3 of indeterminate status were noted. Mean time to realignment was 2 days and mean dura...

  • predicting urethral injury from Pelvic Fracture patterns in male patients with blunt trauma
    The Journal of Urology, 2007
    Co-Authors: Amaya M Basta, Craig C Blackmore, Hunter Wessells
    Abstract:

    Purpose: Precise definition of Pelvic Fracture location may enable prediction of which subjects are at risk for urethral injury and understanding of the pathophysiological mechanism of injury. We determined the specific anterior Pelvic injury locations associated with urethral injury.Materials and Methods: We completed a retrospective, nested case-control study of 119 male patients evaluated at a single large level 1 trauma center between January 1, 1997 and July 15, 2003. We performed detailed measurements of the location, displacement and direction of force of each anterior Pelvic Fracture from computerized tomography and Pelvic radiographs. Multiple logistic regression was used to determine associations between specific Fracture locations and urethral injury after controlling for age, injury mechanism, injury severity and direction of force.Results: Urethral injury was present in 25 patients and all had anterior Pelvic Fracture (inclusive of pubic symphysis diastasis). There were no urethral injuries i...

  • urethral and bladder neck injury associated with Pelvic Fracture in 25 female patients
    The Journal of Urology, 2006
    Co-Authors: Peter C Black, Elizabeth Miller, James Porter, Hunter Wessells
    Abstract:

    Purpose: We describe the presentation, diagnostic evaluation, management and outcome of female urethral trauma.Materials and Methods: All female patients treated at Harborview Medical Center between 1985 and 2001 with urethral injury were identified by International Classification of Diseases 9th revision code. Approval of the Human Subject Division was obtained and patient charts were reviewed. The Urogenital Distress Inventory Short Form, the Incontinence Impact Questionnaire Short Form and the Female Sexual Function Index were sent to the patients.Results: A total of 25 patients (13 adults, 12 children) with a mean age of 22 years (range 4 to 67) met inclusion criteria. All had Pelvic Fracture related to blunt trauma. They represented 6% of all female patients treated in the same review period with Pelvic Fracture. Blood was seen at the introitus in 15 patients and 19 had gross hematuria. Of the injuries 9 were avulsions, 15 were longitudinal lacerations and 1 was not further specified. Primary repair ...

Mamdouh M Koraitim - One of the best experts on this subject based on the ideXlab platform.

  • predictors of surgical approach to repair Pelvic Fracture urethral distraction defects
    The Journal of Urology, 2009
    Co-Authors: Mamdouh M Koraitim
    Abstract:

    Purpose: We identified preoperative factors predictive of the appropriate surgical approach to anastomotic repair of Pelvic Fracture urethral distraction defects.Materials and Methods: We reviewed the medical records and imaging studies of 121 patients who had undergone anastomotic repair of a Pelvic Fracture urethral distraction defect. The review was focused on 10 preoperative clinicoradiological variables that may influence or predict the surgical repair. The patients were categorized as having undergone a simple perineal operation (78 patients, group 1), or an elaborated perineal or a combined perineo-abdominal procedure (43 patients, group 2). Univariate and multivariate analyses were used to identify preoperative parameters predictive of the type of anastomotic repair. In addition, ROC analysis was used to assess prediction results of the multivariate analysis.Results: On univariate analysis 5 parameters were significant predictors of the type of repair, while on multivariate analysis only 3 paramet...

  • Pelvic Fracture urethral injuries the unresolved controversy
    The Journal of Urology, 1999
    Co-Authors: Mamdouh M Koraitim
    Abstract:

    AbstractPurpose: The unresolved controversies about Pelvic Fracture urethral injuries and whether any conclusions can be reached to develop a treatment plan for this lesion are determined.Materials and Methods: All data on Pelvic Fracture urethral injuries in the English literature for the last 50 years were critically analyzed. Studies were eligible only if data were complete and conclusive.Results: The risk of urethral injury is influenced by the number of broken pubic rami as well as involvement of the sacroiliac joint. Depending on the magnitude of trauma, the membranous urethra is first stretched and then partially or completely ruptured at the bulbomembranous junction. Injuries to the prostatic urethra and bladder neck occur only in children. Injury to the female urethra usually is a partial tear of the anterior wall and rarely complete disruption of the proximal or distal urethra. Diagnosis depends on urethrography in men and on a high index of suspicion and urethroscopy in women. Of the 3 conventi...

  • Pelvic Fracture urethral injuries evaluation of various methods of management
    The Journal of Urology, 1996
    Co-Authors: Mamdouh M Koraitim
    Abstract:

    AbstractPurpose: The results of various immediate treatments of urethral injuries complicating a Fractured pelvis were evaluated.Materials and Methods: The records of 100 male patients with Pelvic Fracture urethral injury were reviewed, 73 of whom were treated by suprapubic cystostomy and delayed repair, 23 by primary realignment and 4 by primary suturing. Also, the findings of 771 patients reported in the literature were reviewed.Results: Urethral stricture was an almost inevitable consequence (97 percent of the cases) after suprapubic cystostomy. Primary realignment decreased the incidence of stricture to 53 percent but produced a 36 percent impotence rate. Primary suturing also decreased the incidence of stricture to 49 percent but produced the greatest complication rates for impotence (56 percent) and incontinence (21 percent).Conclusions: Suprapubic cystostomy alone is indicated for incomplete urethral rupture, slight urethral distraction and critically unstable patients, and when there are inadequat...

Christophe E Iselin - One of the best experts on this subject based on the ideXlab platform.

  • the significance of the open bladder neck associated with Pelvic Fracture urethral distraction defects
    The Journal of Urology, 1999
    Co-Authors: George D Webster, Christophe E Iselin
    Abstract:

    AbstractPurpose: As a result of Pelvic Fracture urethral distraction defects, urinary continence relies predominantly on intact bladder neck function. Hence, when cystoscopy and/or cystography reveals an open bladder neck before urethroplasty, the probability of postoperative urinary incontinence may be significant. Unresolved issues are the necessity, the timing and the type of bladder neck repair. We report the outcome of various therapeutic options in patients with Pelvic Fracture urethral distraction defects and open bladder neck. We also attempt to identify prognostic factors of incontinence before urethroplasty.Materials and Methods: We retrospectively reviewed the records of 15 patients with a mean age of 30 years in whom an open bladder neck was identified before posterior urethroplasty between January 1981 and October 1997.Results: Of the 15 patients 6 were continent and 8 were incontinent postoperatively. One patient underwent artificial urethral sphincter implantation simultaneously with Pelvic...

Bryan B Voelzke - One of the best experts on this subject based on the ideXlab platform.

  • risk stratification for erectile dysfunction after Pelvic Fracture urethral injuries
    Urology, 2018
    Co-Authors: Paul H Chung, Cody Gehring, Reza Firoozabadi, Bryan B Voelzke
    Abstract:

    Objective To compare the frequency and severity of erectile dysfunction (ED) among Pelvic Fracture patients with and without urethral injuries and to identify potential risk factors for ED in the setting of Pelvic Fracture injury. Materials and Methods A retrospective review was conducted of male patients treated for Pelvic Fractures with and without urethral injuries at a Level 1 trauma center between 2005 and 2016. The International Index of Erectile Function (IIEF-5) questionnaire was administered to patients by telephone to assess post-injury ED. Additional questions about pre-injury ED, post-injury symptoms, and past medical history were reviewed. Results Fifty patients (42%, n = 118) responded to the IIEF-5 questionnaire: 29 with Pelvic Fractures alone and 21 with PFUIs. We observed a numerical increase in frequency of new onset ED in patients with Pelvic Fracture urethral injuries (PFUIs) (n = 12, 57%) compared with patients with Pelvic Fractures alone (n = 11, 38%) (P = .3). Patients with PFUIs reported lower IIEF-5 scores (ie worse ED) than patients with Pelvic Fractures alone (13 versus 18, P = .05). There were no significant differences in potential risk factors between the 2 groups on univariate analyses. Conclusion ED was more severe following PFUI than Pelvic Fracture alone. We suspect that urethral injury is not the direct cause of ED, but rather a surrogate for extensive Pelvic injury and risk for neurovascular injury. A larger prospective analysis is warranted to clarify this hypothesis and to further stratify risk factors for developing ED in Pelvic Fracture patients with and without urethral injuries.

  • primary realignment of Pelvic Fracture urethral injuries
    Urologic Clinics of North America, 2013
    Co-Authors: Laura Leddy, Bryan B Voelzke, Hunter Wessells
    Abstract:

    : This article reviews the history, indications, technique, complications, and outcomes of primary urethral realignment of Pelvic Fracture urethral injuries. In clinically stable patients, an attempt at endoscopic urethral realignment is appropriate and may result in long-term urethral patency. However, long term follow up is necessary due to elevated rates of delayed stricture formation requiring endoscopic or surgical repair.

  • outcomes of endoscopic realignment of Pelvic Fracture associated urethral injuries at a level 1 trauma center
    The Journal of Urology, 2012
    Co-Authors: Laura Leddy, Hunter Wessells, Alex J Vanni, Bryan B Voelzke
    Abstract:

    Purpose: We examined the success of early endoscopic realignment of Pelvic Fracture associated urethral injury after blunt Pelvic trauma.Materials and Methods: A retrospective review was performed of patients with Pelvic Fracture associated urethral injury who underwent early endoscopic realignment using a retrograde or retrograde/antegrade approach from 2004 to 2010 at a Level 1 trauma center. Followup consisted of uroflowmetry, post-void residual and cystoscopic evaluation. Failure of early endoscopic realignment was defined as patients requiring urethral dilation, direct vision internal urethrotomy, posterior urethroplasty or self-catheterization after initial urethral catheter removal.Results: A total of 19 consecutive patients (mean age 38 years) with blunt Pelvic Fracture associated urethral injury underwent early endoscopic realignment. Twelve cases of complete urethral disruption, 4 of incomplete disruption and 3 of indeterminate status were noted. Mean time to realignment was 2 days and mean dura...