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• W3192470189 abstract "You have accessJournal of UrologyLower Tract Reconstruction (V10)1 Sep 2021V10-09 MANAGING FEMALE PELVIC FRACTURE URETHRAL DISTRACTION DEFECT (PFUDD): CONTEMPORARY MANAGEMENT AND TREATMENT OPTIONS Pankaj M. Joshi, Marco Bandini, Shreyas Bhadranavar, Amey Patil, Vipin Sharma, Yatam L. Shreeranga, Guido Barbagli, Francesco Montorsi, and Sanjay B. Kulkarni Pankaj M. JoshiPankaj M. Joshi More articles by this author , Marco BandiniMarco Bandini More articles by this author , Shreyas BhadranavarShreyas Bhadranavar More articles by this author , Amey PatilAmey Patil More articles by this author , Vipin SharmaVipin Sharma More articles by this author , Yatam L. ShreerangaYatam L. Shreeranga More articles by this author , Guido BarbagliGuido Barbagli More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Sanjay B. KulkarniSanjay B. Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002061.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PFUDD in female patients is a rare and challenging condition. The injury can be at bladder neck-proximal urethra, mid, or distal urethra. There is usually an associated urethro-vaginal fistula (UVF). Diagnostic workflow and surgical management of these patients is not standardized, and for this reason the outcomes are unknown. To date, no large series of female patients have been published. We aimed to present our experience on female patients with PFUDD treated at our referral center over 30 years of practice. METHODS: We prospectively collected (1995-2021) surgical and clinical data of all girls and women referred to our center for PFUDD repair. All patients received pelvic MRI and were evaluated under general anesthesia at time of surgery to allow the identification of UVF, but also to inspect the distal part of urethra and vaginal introitus. Uroflow was performed after surgery to assess the success of the operation. Urinary continence was also assed after surgery using voiding diary. RESULTS: We retrieved data of 22 patients: 10 girls (median 9yrs) and 12 women (median 25yrs). Median time from injury to surgery was 10mo. Overall, 5 (22.7%, 4 girls/1 women), 10 (45.5%, 4 girls/6 women), and 6 (27.3%, 2 girls/ 4 women) presented proximal, mid, and distal urethral injury. One case had whole urethral loss. All proximal PFUDD had UVF. They were approached transabdominally with partial pubectomy (posterior and superior), urethral isolation, UVF closure with omental interposition, and urethral anastomosis (or urethro-bladder neck anastomosis in bladder neck injuries). Of the 10 mid PFUDD patients, 8 (80%) were approached transabdominally and 6/8 received UVF repair. Two patients with mid PFUDD presented a transverse vaginal septum that was treated by vaginal pull through. All 6 distal PFUDD patients were approached transvaginal, and two presented vaginal introital stenosis requiring episiotomy. Overall, 17/22 (77.3%) were continent at night and day; of those 3/5 (60%) with proximal PFUDD. Median postoperative Qmax was 18ml/min. After 36mo of median follow-up of, only one patient with proximal PFUDD required redo surgery, but was continent thereafter. CONCLUSIONS: Initial assessment of female patients with PFUDD requires MRI and careful genital examination, because UVF is a common feature, especially in proximal and mid PFUDD. Vaginal approach should be used only for distal PFUDD and mid PFUDD without UVF. Continence after surgery is seen in majority of patients. At our tertiary referral center, we have a high success rate for female PFUDD. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e757-e757 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pankaj M. Joshi More articles by this author Marco Bandini More articles by this author Shreyas Bhadranavar More articles by this author Amey Patil More articles by this author Vipin Sharma More articles by this author Yatam L. Shreeranga More articles by this author Guido Barbagli More articles by this author Francesco Montorsi More articles by this author Sanjay B. Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W3192470189 title "V10-09 MANAGING FEMALE PELVIC FRACTURE URETHRAL DISTRACTION DEFECT (PFUDD): CONTEMPORARY MANAGEMENT AND TREATMENT OPTIONS" @default.
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