Posterior Urethra

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The male urethra is divided into the anterior and posterior urethra. The posterior urethra consists of the segment that extends from the bladder neck to the distal external urethral sphincter and can be divided into the prostatic urethra and the membranous urethra. The anterior urethra extends from the distal external urethral sphincter to the external urinary meatus and is divided into the bulbar, penile and navicularis urethra. The posterior urethra includes the two urinary sphincters, at the level of the bladder neck (proximal urinary sphincter) and at the level of membranous urethra (distal urinary sphincter).
Lecture n° 1:

Initial evaluation and management of the patient with pelvic fracture urethral distraction defects (PFUDD)
1 December 2007
Rome — Italy

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Lecture n° 2:
Incontinence following pelvic trauma
23rd Annual EAU Congress
Sub-plenary Session on Male urinary incontinence
March 26-29, 2008
Milan — Italy

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Lecture n° 3:
Posterior Urethroplasty
III Simposio Internacional de Cirurgia Urologica Reconstrutora
April 11-12, 2008
Rio de Janeiro-Brazil

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Lecture n° 4:
Chirurgia dell’uretra posteriore
Mantova — Italy

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Lecture n° 5:
Traumatic posterior urethral disruption. Pelvic fracture urethral distraction defects
Congress of French Association of Urology
ESU COURSE: Trauma in Urology
November, 20 — 2008
Paris – France

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Lecture n° 6:
Acute management of posterior urethral trauma. What are the options and what is the current consensus
Muljibhai Patel Urological Hospital “URETHROPLASTY”
July 19 – 20, 2012
Nadiad – Gujarat – India

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Lecture n° 7:
Emergency and delayed treatment of patients with pelvic fracture urethral distraction defects
9th Conference of the Arab Association of Urology
7th International Conference of Jordanian Association of Urological Surgeons
November 22 — 24, 2011
Amman – Jordan

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Article n° 1
Urethral trauma: radiological aspects and treatment options.
J Trauma. 1987 Mar; 27(3):256-61  

Experience with treatment of 38 patients in an early phase with urethral trauma is presented. The site of injury was the penile urethra in three cases, the bulbous urethra in seven, and the prostatomembranous urethra in 28. Different surgical procedures were used, according to the site and the extent of urethral damage and the presence of associated lesions. All patients with penile and bulbous urethral trauma were cured and only one has diminished sexual potency, while in the posterior urethral group nine were cured, and 19 developed strictures requiring further surgical treatment. Total impotence developed in 17 and partial impotence in one patient. Another case presents urinary urge incontinence.

Article n° 2
Posterior urethroplasty in children.
Eur Urol. 1987;13(1-2):110-5.  

A series of 33 posterior urethral strictures in children is presented. The etiology was traumatic in 31 cases and iatrogenic in 2. Complex strictures were treated by a transpubic approach (20 cases) or by a posterior scroto-urethral inlay (1 case). Simple strictures were directly treated via the perineum: by a push-in technique (6 cases); by end-to-end anastomosis (3 cases); by a skin pedicled tube urethroplasty (1 case); by free skin graft (1 case), and by endoscopic urethrotomy (1 case). The use of omentum, employed in 19 cases, is considered a necessary step in transpubic urethroplasty. Favorable results were observed in 18 out of 20 transpubic procedures, in 8 out of 9 perineal urethroplasties and in 3 out of 4 other techniques, with an overall success rate of 87.8%.

Article n° 3
Long-term results of anterior and posterior urethroplasty with actuarial evaluation of the success rates.
J Urol. 1997 Oct;158(4):1380-2.  

Purpose: We analyzed the long-term results of different urethroplasty techniques.
Materials and methods: We performed a retrospective review of 98 patients who underwent different procedures for anterior (78) and posterior (20) urethral strictures. Mean followup was 53 months. A total of 20 patients underwent end-to-end anastomosis (group 1), 30 underwent 1-stage procedures (group 2), 28 underwent 2-stage procedures (group 3), and 20 underwent bulboprostatic anastomosis (group 4). The results were analyzed using Kaplan-Meier curves and log rank test.
Results: The success rate was 95% for group 1, 93.4% for group 2, 78.6% for group 3, and 70% for group 4. Statistical evaluation of the actuarial success rates failed to show significant differences among the 4 groups.
Conclusions: The stricture recurrences were uniformly distributed over time. Urethroplasty patients must be followed for the rest of their lives.

Articolo n° 4
History and Evolution of Transpubic Urethroplasty:
A Lesson for Young Urologists in Training

Eur Urol 2007; 52:1290 — 1292  

1. Question: What kind of anesthesia is used for this surgery?
Answer: General anesthesia with oro-tracheal intubation.

2. Question: How many hours does the surgery take?
Answer: About 3 hours.

3. Question: Are there any risks concerning erection, fertility and continence after the surgery?
Answer: If the bladder neck was not injured during the pelvic trauma or emergency treatment, the posterior urethroplasty is safe with regard to urinary continence. The preoperative radiological study provides sure information about the integrity of the bladder neck. Patients with pelvic trauma and urethral rupture may show some degree of erectile dysfunction, due to urethral disruption. Posterior urethroplasty may cause erectile dysfunction. If the bladder neck is not damaged the fertility is not at risk.

4. Question: How many days of hospital recovery are expected following the surgery?
Answer: In general, from 5 to 7 days.

5. Question: How long will I have to use a urethral catheter and suprapubic tube after the surgery?
Answer: The urethral catheter must stay in place for four weeks following surgery, when the first post-operative voiding urethrography is done. The suprapubic tube must stay in place for two months following surgery, when the second post-operative voiding urethrography is done.

6. Question: Are there any particular recommendations during convalescence?
Answer: During convalescence, antibiotic use is suggested until the catheter is removed. It is also suggested that long car trips be avoided, as well as heavy labor, sexual activity and sports.

7. Question: When will I be able to resume work, sexual activity and sports?
Answer: All these activities can be gradually resumed after the removal of the catheter.

8. Question: Can I ride a bike or a motorcycle immediately after the surgery?
Answer: It is not recommended to ride bikes, motorcycles or horses after the surgery.

9. Question: What kinds of foods and drinks should be avoided after the surgery?
Answer: Beer and sparkling wines should be avoided, as well as large quantities of chocolate, cocoa, nuts and shellfish.