The recently published paper "A novel anterior bladder tube for traumatic bladder neck contracture in females: initial results" demonstrates an ingenious way of repair of bladder neck contracture and urethral loss in females presenting after traumatic pelvic fracture associated injury.
The idea for this technique came midway through the surgery in the first such case. There was a long three cm gap to be bridged. Given the severity of fibrosis in this particular case, the inherent possibility of incontinence and tension on the anastomosis with conventional anterior bladder flap procedure was present, which lead to the imaginations running high for making some modifications to the technique. The scientific basis of the old technique was revisited and improvements suggested maintaining the principles for providing continence. In fact, as we found out we ended up providing a better theoretical basis on all counts. The best possible results with respect to urethral patency, voiding function, and above all full continence encouraged us to use the same technique for two more cases, both with equally good results.
The technique itself is simple and should be reproducible in most hands. It is based on some sound background principles particularly with respect to how it can achieve continence in these otherwise very challenging surgical reconstructions. Our initial results have been very encouraging. Once the literature on the use of this technique expands, we will generate results that are long term and from multiple centers. Until then, this technique surely provides another option for managing these difficult cases.
Written by: Rishi Nayyar, MS, MCh, FMAS, Associate Professor, Department of Urology, All India Institute Of Medical Sciences, New Delhi, India
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Written by: Rishi Nayyar, MS, MCh, FMAS, Associate Professor, Department of Urology, All India Institute Of Medical Sciences, New Delhi, India
Read the Abstract