Bulbar urethral necrosis: current concept and novel comprehensive classification

What is it about?

Bulbar urethral necrosis (BUN), is a complex variant of pelvic fracture urethral injury (PFUI) associated with vascular damage, generally developed after primary repair. This study analyzed retrograde urethrograms from 145 patients to develop a radiological classification of BUN. BUN was classified into four radiological types based on the relationship between the penile and bulbar urethra and the position of the distal stump relative to the ischium, with Type 3 being the most common, indicating complete loss of the bulbar urethra. The proposed classification aims to predict the difficulty level in performing substitution urethroplasty, providing a clinical tool to aid in surgical planning. This research concludes that understanding the vascular supply is crucial in managing and preventing BUN.

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Photo by CHUTTERSNAP on Unsplash

Photo by CHUTTERSNAP on Unsplash

Why is it important?

By developing a classification system, this study aims to improve the predictability and management of surgical procedures for patients with BUN, thereby potentially increasing the success of urethroplasty. Key Takeaways: 1. This study reveals that bulbar urethral necrosis is primarily defined by the absence of a segment of the bulbar urethra, typically following previous pelvic fracture urethral injury repairs, with its pathophysiology being mainly vascular in nature. 2. Findings demonstrate a novel radiological classification of BUN into four types based on the relationship between the penile and bulbar urethra and the position of the distal stump relative to the ischium, with Type 3 being the most prevalent. 3. The research indicates that the proposed radiological classification can help predict the level of difficulty for substitution urethroplasty, thereby aiding in the surgical planning and potentially improving patient outcomes.