الفهرس 
Acknowledgement
Anatomy of pelvic bonesOnly 14 pages are availabe for public view
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Abstract
PFUDDIs are complex pathologically, involving displacement and misalignment of the severed urethral ends with intervening and surrounding fibrosis. Detached bony fragments and callus formation add to the pathological complexity. For a successful repair of a PUDDI it is necessary to identify the specific anatomy of the distraction defect before undertaking any treatment. The success rate of repeated surgery for failed urethroplasty is reported to be less than that for primary urethroplasty. Jakse et al; reported a 71% failure rate following end-to-end urethroplasty with a history of prior urethroplasty. Our study is prospective cohort study performed at Asyut urology and nephrology hospital between April 2016 and February 2019 , included 41 patients diagnosed as failed anastomotic urethroplasty patients with age range 29.85 ± 10.41 (17.0-52.0) years, 38 patients 92.7% managed at time of trauma by supra pubic tube 3 patients7.3% managed by primary endoscopic realignment. Later on all patients managed by anastomotic urethroplasty, time elapsed between urethroplasty and failure ranges between 6-18 months 35 patients 85.4% presented with suprapubic tube and 6 patients14.6% presented with acute retention needed supra pubic tube . In our study causes of pelvic fracture involving MCA 46.3% MBA 31.7 FFH 22 %.In our study the site of recurrence was at the anastomotic site in 85.4% and the bulbar urethra in 14.6% of cases by 3D CTCUG but 95.1% of cases were at the anastomotic site and 4.9% of cases the defect was at the bulbar urethra by RUG while intraoperative the site was found at the nastomotic site in87.8% of cases and 12.2% at the bulber urethra , although no significant statistical difference between 3D CTCUG and RUG in determination of the site of defect the intraoperative findings found raising value of 3D CTCUG for better determination of site of PFUDDI. In our study the measured length using 3D CTCUG was (3.92 ± 0.77 cm) and was found to be (3.47 ± 0.67 cm) by RUG in comparison with intraoperative finding which found (3.90 ± 0.76 cm) with no significant statistical difference between length using 3D CTCUG (P value0.094) and operative finding while there was significant difference between the mean length measured by RUG (p value 0.003) and the mean length of PFUDDI found intraoperative in our study which supports the accuracy of 3D CTUCG in determination of length of PFUDDI In our study the fistula was detected in 4 patients 9.8% by both 3D CTCUG and RUG combined with MCU while intraoperatively 5 patients were found to have urethrorectal fistula with detection rate 80% with proper prescription of anatomy and its relation with the urethral defect by 3DCTCUG. In our study 5 patients(12.2%) found to have stone at prostatic urethra which was not detected by KUB or during RUG. The longer the length of PFUDDI by 3D CTCUG the more dissection with longer operative time ,In our study 11 (26.8%) patients had operation time less than 180 minutes with mean length of defect was (3.03 ± 0.32cm) by 3D CTCUG , 20 (48.8%)patients had operation time 180minutes with mean length of (3.96 ± 0.45cm) by 3D CTCUG while10 (24.4%) patients had operation time more than 180 minutes with mean length of (4.84 ± 0.45cm) by 3D CTCUG . 3D CTUCG also provide more important details about degree of alignment or malalignment of both end of the urethral defect which is essential for predicting need for inferior pubectomy or need for blood transfusion. In our study 18 patients (43.9%) found to have ectopic bone fragment related to urethral defect by 3D CTCUG while intra operatively 20 patients 48.8%were found to have ectopic bone fragment with no statistically significance difference but combined RUG and MUG not provide detailed anatomy. 18 patients needed blood transfusion more than 500 cc (43.9 %) when the mean length of urethral defect was (4.34 ± 0.66 cm) by 3D CTCUG while patients who needed blood transfusion less than 500cc had mean length of “(3.60 ± 0.71 cm) by 3D CTCUG which creates direct proportional relationship between length by 3D CTCUG and need for blood transfusion but no significant value between blood transfusion and other pathology as stones, fistula and ectopic bones fragments. 3D CTCUG is a promising tool for defining male urethral PFUDDI as an alternative to traditional radiographic methods. With the advantage of examining only in one position, without distortion and with generation 3D images in the tests 3D CTCUG provides more benefits over traditional methods including the accurate measurement of lesions and detection of other pathologies as stones at prostatic urethra and rectal fistula which important for surgery planning. 3D CTCUG can accurately measure the PFFUDDI length, aid in the diagnosis of some associated pathological conditions, such as urethrorectal fistula, and is devoid of doctor’s radiation exposure.