Progressive Perineal Urethroplasty (PPU) For Pelvic
Fracture Urethral Injuries (PFUDD)
In New Delhi India
Dr Vijayant Govinda Gupta is an expert in progressive perineal urethroplasty or PPU in Delhi India. Progressive perineal urethroplasty or PPU is a surgery and the only long lasting solution for Pelvic Fracture Urethral Injuries. If you have had a fracture pelvis and are on a supra pubic catheter, then you may be suffering from PFUDD and you need PPU.
Pelvic Fracture Urethral Distraction Defect (Pfudd)
Pelvic fracture urethral distraction defect or PFUDD is the name given to a medical condition that occurs in patients of fracture pelvis. In developing countries, road traffic accidents or injuries with tractors or buses is common. These injuries commonly cause the pelvis (or the hip buttock bones) to fracture.
The urinary bladder or urine bag lies in side the pelvic bones, protected from the outside. While the penis and the urethra lie outside the confines of the pelvic bone and musculature. During the injury, due to bleeding or due to direct trauma (evidence is mixed), the urine pipe or the urethra seperates from the urinary bladder and the prostate. Imagine a apple plucked from a branch.
So, most commonly patients will present to the emergency room with blood present at the tip of the penis and inability to pass urine. The stomach gets swollen and pain occurs due to urine getting trapped in the bladder.
Usually a doctor will try to pass a pipe from the tip of the penis to empty the urine, but in PFUDD, this usually impossible to do. In this situation, the doctor will place a suprapubic catheter or SPC into the stomach to drain the urine. Most patients will heal their fractures, but still remain on their spc or suprapubic catheter till some surgery is done to reestablish the correct path.
The image below shows how this defect looks on a MCU/RGU. You can read about this test here.
PPU / Progressive Perineal Urethroplasty
PPU or Progressive perineal urethroplasty or perineal urethroplasty is a surgical technique developed in the 1980’s in England, that in the current times provides the best results for PFUDD.
In this surgery, the surgeon will reconstruct the urethra and reconnect it to your baldder. This will help you get rid of your spc/suprapubic catheter and void from below.
Many patients develop erectile dysfunction after the fracture. This surgery also ensures that it does not worsen erectile dysfunction, but it can rather improve erectile function in some patients.
You may need a penile implant post PPU in some cases.
What To Expect After PPU For PFUDD?
Normally, PPU can be performed once the fracture has healed, and the patient has resumed walking. Usually waiting for 3 to 4 months after the injury is prudent to get the best results. During this waiting period, you will undergo physiotherapy for your pelvic fracture, gain strength and regain function of your muscles and your penis.
After 2 months, a MCU RGU will be performed to define the injury. Once the injury is well defined, you will undergo surgery.
I perform the surgery in regional anaesthesia. The surgery duration is approxiamtely 2 hours. You will stay in the hospital for 1 week after the surgery for dressing and antibiotics. You will stay on your spc and one catheter that will put through your urine pipe. This urethral catheter will come out after 21 days, when we expect you to void with a good flow.
What Complications After PPU PFUDD?
- Erectile Dysfunction – It has been proven that the erectile dysfunction is due to the primary injury. Usually the surgery will not cause deterioration, but over time you may actually feel improvement in your erections. I also specialist in penile implantsand management of erectile dysfunction.
- Inability to void – PPU is a complex surgery, pfudd is a complex disease. All patients do not get perfect in one attempt. 10% of patients may need additional procedures depending on the complexity of your case. But, I have a good expertise in this surgery, so in straightforward cases, I expect you to do very well after surgery.
Alternatives To PPU And PFUDD Treatment
Some surgeons (who are not trained in this complex surgery) advise endoscopic management of PFUDD. Though, very tempting from the patients point of view to avoid a major surgery, the results of endoscopic surgery are vastly inferior to PPU. I do not perform endoscopic management of PFUDD and I condemn it to the realm of quacks. SOme exceptional cases may benefit from endoscopic management, but they require very careful evaluation.
