3D printing of pelvic fracture urethral injuries-fusion of technology and urethroplasty

Özet

Objective: Urethral injury occurs in 10% of patients who suffer from pelvic fractures. Urethroplasty isperformed after an interval of 3 months to stabilize the perineal hematoma. It has been reported that the ratelimiting step in anastomotic urethroplasty is finding the posterior urethra. Even for the most experiencedsurgeons, at times, this step can be challenging. The aim of the present study was to describe a novel tech-nique for understanding the three-dimensional (3D) anatomy which would also help in surgical planning andmaking urethroplasty easy, a step ahead of conventional imaging.Material and methods: Ours is a tertiary referral center with an experience of >1307 cases of pelvic fractureurethral distraction defects. This study was conducted between January 2018 and July 2018. Ethics approvalwas obtained. No patients incurred any cost for the study. A computerized tomography scan was performedwith the bladder filled with contrast saline, and the same solution was injected into the anterior urethra, witha gauze piece tied around the glans. 3D images were then reconstructed, and data were transferred to the 3DUltimakerTM printer. 3D models were printed to mimic the anatomy of pelvic fracture urethral distraction.Results: A total of 10 models were created. The models, along with conventional urethrogram, were shownto fellows and observers. Visually, they gave a score of 4.3/5. In correlation with urethroplasty, understand-ing the anatomy of the posterior urethra was also important.Conclusion: 3D printing can be applied to pelvic fracture urethral injury to understand the anatomy of theposterior urethra, its distance from the rectum, length of gap, relation to the posterior urethra, direction ofdisplacement of the urethra, and if pubectomy is required or not.