Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty

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 periop...

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Main Authors: L. A. Bertrand, S. P. Elliott, B. N. Breyer, B. A. Erickson
Format: Article
Language:English
Published: Wiley 2015-01-01
Series:Case Reports in Urology
Online Access:http://dx.doi.org/10.1155/2015/646784
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author L. A. Bertrand
S. P. Elliott
B. N. Breyer
B. A. Erickson
author_facet L. A. Bertrand
S. P. Elliott
B. N. Breyer
B. A. Erickson
author_sort L. A. Bertrand
collection DOAJ
description 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.
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spelling doaj-art-d39778134cdc482d8d1d3087f47f3ef82025-02-03T00:59:34ZengWileyCase Reports in Urology2090-696X2090-69782015-01-01201510.1155/2015/646784646784Management of Delayed Onset Postoperative Hemorrhage after Anastomotic UrethroplastyL. A. Bertrand0S. P. Elliott1B. N. Breyer2B. A. Erickson3Department of Urology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 3RCP, Iowa City, IA 52242, USADepartment of Urology, University of Minnesota, 420 Delaware Street, SE b435, Minneapolis, MN 55455, USADepartment of Urology, University of California San Francisco, 1001 Potrero Avenue, SFGH 3, San Francisco, CA 94110, USADepartment of Urology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 3RCP, Iowa City, IA 52242, USAExcision 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.http://dx.doi.org/10.1155/2015/646784
spellingShingle L. A. Bertrand
S. P. Elliott
B. N. Breyer
B. A. Erickson
Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty
Case Reports in Urology
title Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty
title_full Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty
title_fullStr Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty
title_full_unstemmed Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty
title_short Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty
title_sort management of delayed onset postoperative hemorrhage after anastomotic urethroplasty
url http://dx.doi.org/10.1155/2015/646784
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