Immediate urethral reconstruction performed during rectal cancer surgery resulted in preserved urinary function and no evidence of stricture or incontinence through 4 years of follow-up, according to a case report.
The report described a 57-year-old male patient with advanced rectoanal cancer who underwent laparoscopy-assisted abdominoperineal resection. During anterior rectal wall dissection, surgeons inadvertently exposed the urethral catheter and identified a partial tear of the dorsal half of the membranous urethra, likely caused by electrocautery.
An intraoperative urology consultation was obtained. The injury measured approximately 10 mm and involved a semicircumferential defect of the dorsal urethra. Because the tissue damage was minimal, no trimming was required. The surgeons repaired the defect using five interrupted absorbable sutures and confirmed a watertight closure with saline injection through the external urethral meatus.
Retrograde urethrocystography performed on postoperative day 15 demonstrated no urinary extravasation or urethral stricture, allowing for urethral catheter removal. Voiding cystourethrography also showed no evidence of stricture during urination. The patient subsequently demonstrated a strong urinary stream without postvoid residual urine.
At 5 months, flexible cystoscopy showed no anastomotic stricture, and uroflowmetry findings remained satisfactory. The patient continued to report no urinary incontinence or decreased urinary stream at 4 years postsurgery.
The researchers noted that urethral injury during rectal surgery may be more common than previously recognize. Reported incidence ranges from 0.1% to 2% during abdominoperineal resection and approximately 0.8% during transanal total mesorectal excision. The risk may increase during the learning curve associated with newer rectal surgical techniques.
The membranous urethra is particularly vulnerable because of its close anatomic relationship to the rectum. Prior studies have reported that the distance between the rectum and membranous urethra may be as little as 0.2 cm. Injury to this region also raises concerns about postoperative urinary continence because the membranous urethra contributes to sphincter function.
The researchers suggested that immediate reconstruction may be appropriate when the patient's condition is stable and a tension-free repair can be achieved. However, they noted that delayed reconstruction may remain preferable when extensive mobilization would be required.
“This is the first report of immediate urethral reconstruction for a urethral injury sustained during rectal surgery, performed according to standard reconstructive principles and resulting in satisfactory voiding function,” wrote lead study author Sou Kimura, of the Department of Urology at the Toyama Rosai Hospital in Japan.
The study authors reported no conflicts of interest.
Source: IJU Case Reports
