Work

Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty

Year: 2015

Type: article

Abstract: Excision with primary anastomosis (EPA) urethroplasty is generally the preferred method for short strictures in the bulbar urethra, given its high success rate and low complication rate compared to other surgical interventions. Bleeding is a presumed risk factor for any surgical procedure but perioperative hemorrhage after an EPA requiring hospitalization and/or reintervention is unreported with no known consensus on the best course for management. Through our experience with three separate cases of significant postoperative urethral hemorrhage after EPA, we developed an algorithm for treatment beginning with conservative management and progressing through endoscopic and open techniques, as well as consideration of embolization by interventional radiology. All the three of these cases were managed successfully though they did require multiple interventions. We theorize that younger patients with more robust corpus spongiosum and more vigorous spontaneous erections, patients that have undergone fewer prior urethral procedures and therefore have more prominent vasculature, and those patients managed with a two-layer closure of the ventral urethra without ligation of the transected bulbar arteries are at a higher risk for this complication.

Source: Case Reports in Urology

DOI: 10.1155/2015/646784

Authors: L. A. Bertrand, S. P. Elliott, B. N. Breyer, B. A. Erickson

Institutions: University of Iowa Hospitals and Clinics, University of Minnesota, San Francisco General Hospital, University of California, San Francisco

Language: English

Topic: Urological Disorders and Treatments

Subfield: Urology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $790