Laparoscopic Omentoplasty to Support Anastomotic Urethroplasty in Complex and Redo Pelvic Fracture Urethral Defects

Sanjay B. Kulkarni, Guido Barbagli, Pankaj M. Joshi, Craig Hunter, Walid Shahrour, Jyotsna Kulkarni, Salvatore Sansalone, Massimo Lazzeri

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective To test the hypothesis that a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex and prior failed pelvic fracture urethral defect repair was feasible, safe, and effective. Methods We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approach for urethroplasty in patients with pelvic fracture urethral defect at a single center in Pune, India, between January 2012 and February 2013. Complex and redo patients with pelvic fracture urethral defect occurring after pelvic fracture urethral injury were included in the study. Anterior urethral strictures were excluded. The primary study outcome was the success rate of the surgical technique, and the secondary outcome was to evaluate feasibility and safety of the procedure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Results Fifteen male patients with a median age of 19 years were included in the study. Seven patients were adolescents (12-18 years) and 8 patients (53.3%) were adults (19-49 years). The mean number of prior urethroplasties was 1.8 (range, 1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to envelope the anastomosis and to fill the perineal dead space. Of 15 patients, 14 (93.3%) were successful and 1 (6.6%) failed. One adolescent boy 14 years old developed a recurrent stricture 2 months after the procedure and was managed using internal urethrotomy. Median follow-up was 18 months (range, 13-24 months). Conclusion Combining a laparoscopic omentoplasty to a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is successful, feasible, safe, and with minimal additional morbidity to the patient. The technique has the advantage of a perineal incision and the ability to use the omentum to support the anastomosis.

Original languageEnglish
Article number19065
Pages (from-to)1200-1205
Number of pages6
JournalUrology
Volume85
Issue number5
DOIs
Publication statusPublished - May 1 2015

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Omentum
Urethral Stricture
Perineum
Wounds and Injuries
India
Pathologic Constriction
Outcome Assessment (Health Care)
Morbidity
Safety

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Kulkarni, S. B., Barbagli, G., Joshi, P. M., Hunter, C., Shahrour, W., Kulkarni, J., ... Lazzeri, M. (2015). Laparoscopic Omentoplasty to Support Anastomotic Urethroplasty in Complex and Redo Pelvic Fracture Urethral Defects. Urology, 85(5), 1200-1205. [19065]. https://doi.org/10.1016/j.urology.2014.12.055

Laparoscopic Omentoplasty to Support Anastomotic Urethroplasty in Complex and Redo Pelvic Fracture Urethral Defects. / Kulkarni, Sanjay B.; Barbagli, Guido; Joshi, Pankaj M.; Hunter, Craig; Shahrour, Walid; Kulkarni, Jyotsna; Sansalone, Salvatore; Lazzeri, Massimo.

In: Urology, Vol. 85, No. 5, 19065, 01.05.2015, p. 1200-1205.

Research output: Contribution to journalArticle

Kulkarni, SB, Barbagli, G, Joshi, PM, Hunter, C, Shahrour, W, Kulkarni, J, Sansalone, S & Lazzeri, M 2015, 'Laparoscopic Omentoplasty to Support Anastomotic Urethroplasty in Complex and Redo Pelvic Fracture Urethral Defects', Urology, vol. 85, no. 5, 19065, pp. 1200-1205. https://doi.org/10.1016/j.urology.2014.12.055
Kulkarni SB, Barbagli G, Joshi PM, Hunter C, Shahrour W, Kulkarni J et al. Laparoscopic Omentoplasty to Support Anastomotic Urethroplasty in Complex and Redo Pelvic Fracture Urethral Defects. Urology. 2015 May 1;85(5):1200-1205. 19065. https://doi.org/10.1016/j.urology.2014.12.055
Kulkarni, Sanjay B. ; Barbagli, Guido ; Joshi, Pankaj M. ; Hunter, Craig ; Shahrour, Walid ; Kulkarni, Jyotsna ; Sansalone, Salvatore ; Lazzeri, Massimo. / Laparoscopic Omentoplasty to Support Anastomotic Urethroplasty in Complex and Redo Pelvic Fracture Urethral Defects. In: Urology. 2015 ; Vol. 85, No. 5. pp. 1200-1205.
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abstract = "Objective To test the hypothesis that a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex and prior failed pelvic fracture urethral defect repair was feasible, safe, and effective. Methods We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approach for urethroplasty in patients with pelvic fracture urethral defect at a single center in Pune, India, between January 2012 and February 2013. Complex and redo patients with pelvic fracture urethral defect occurring after pelvic fracture urethral injury were included in the study. Anterior urethral strictures were excluded. The primary study outcome was the success rate of the surgical technique, and the secondary outcome was to evaluate feasibility and safety of the procedure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Results Fifteen male patients with a median age of 19 years were included in the study. Seven patients were adolescents (12-18 years) and 8 patients (53.3{\%}) were adults (19-49 years). The mean number of prior urethroplasties was 1.8 (range, 1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to envelope the anastomosis and to fill the perineal dead space. Of 15 patients, 14 (93.3{\%}) were successful and 1 (6.6{\%}) failed. One adolescent boy 14 years old developed a recurrent stricture 2 months after the procedure and was managed using internal urethrotomy. Median follow-up was 18 months (range, 13-24 months). Conclusion Combining a laparoscopic omentoplasty to a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is successful, feasible, safe, and with minimal additional morbidity to the patient. The technique has the advantage of a perineal incision and the ability to use the omentum to support the anastomosis.",
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AU - Hunter, Craig

AU - Shahrour, Walid

AU - Kulkarni, Jyotsna

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N2 - Objective To test the hypothesis that a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex and prior failed pelvic fracture urethral defect repair was feasible, safe, and effective. Methods We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approach for urethroplasty in patients with pelvic fracture urethral defect at a single center in Pune, India, between January 2012 and February 2013. Complex and redo patients with pelvic fracture urethral defect occurring after pelvic fracture urethral injury were included in the study. Anterior urethral strictures were excluded. The primary study outcome was the success rate of the surgical technique, and the secondary outcome was to evaluate feasibility and safety of the procedure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Results Fifteen male patients with a median age of 19 years were included in the study. Seven patients were adolescents (12-18 years) and 8 patients (53.3%) were adults (19-49 years). The mean number of prior urethroplasties was 1.8 (range, 1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to envelope the anastomosis and to fill the perineal dead space. Of 15 patients, 14 (93.3%) were successful and 1 (6.6%) failed. One adolescent boy 14 years old developed a recurrent stricture 2 months after the procedure and was managed using internal urethrotomy. Median follow-up was 18 months (range, 13-24 months). Conclusion Combining a laparoscopic omentoplasty to a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is successful, feasible, safe, and with minimal additional morbidity to the patient. The technique has the advantage of a perineal incision and the ability to use the omentum to support the anastomosis.

AB - Objective To test the hypothesis that a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex and prior failed pelvic fracture urethral defect repair was feasible, safe, and effective. Methods We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approach for urethroplasty in patients with pelvic fracture urethral defect at a single center in Pune, India, between January 2012 and February 2013. Complex and redo patients with pelvic fracture urethral defect occurring after pelvic fracture urethral injury were included in the study. Anterior urethral strictures were excluded. The primary study outcome was the success rate of the surgical technique, and the secondary outcome was to evaluate feasibility and safety of the procedure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Results Fifteen male patients with a median age of 19 years were included in the study. Seven patients were adolescents (12-18 years) and 8 patients (53.3%) were adults (19-49 years). The mean number of prior urethroplasties was 1.8 (range, 1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to envelope the anastomosis and to fill the perineal dead space. Of 15 patients, 14 (93.3%) were successful and 1 (6.6%) failed. One adolescent boy 14 years old developed a recurrent stricture 2 months after the procedure and was managed using internal urethrotomy. Median follow-up was 18 months (range, 13-24 months). Conclusion Combining a laparoscopic omentoplasty to a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is successful, feasible, safe, and with minimal additional morbidity to the patient. The technique has the advantage of a perineal incision and the ability to use the omentum to support the anastomosis.

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