Abstract
ObjectivesThe aim of our study is to assess the value of deferred endoscopic urethral realignment after traumatic posterior urethral disruption. Patients and methodsBetween June 2001 and August 2011, we evaluated 28 patients who presented 3–6 weeks (mean 27±6 days) after experiencing traumatic posterior urethral disruptions and pelvic fractures; immediate and early realignment were overdue in these cases. Patient variables included mode of presentation, mechanism of trauma, type of pelvic fracture, and Abbreviated Injury Scale (AIS). Under fluoroscopic guidance, a guidewire was passed into the injured urethral segment from the distal to proximal injured ends using a long Chiba needle, and realignment was performed using endoscopic urethrotomy. The follow-up period ranged from 18 to 98 months (mean 43±22.5 months). ResultsAfter the procedure, 46% of patients were stricture free. After one visual internal urethrotomy (VIU) and two VIU's, 60% and 64% of patients were stricture free. No cases of post-procedural incontinence occurred, and impotence was reported in only 14% of patients. Type of pelvic fracture was the only variable that significantly affected the success rate, where the success rate decreased from 100% in stable pelvic fracture to 25% in bilateral rotationally and vertically unstable pelvic fracture. ConclusionWhen early realignment is postponed for any reason, deferred endoscopic realignment is considered an adequate substitute because urethral continuity can be achieved in a group of patients without increase incidence of impotence and incontinence.
Highlights
When early realignment is postponed for any reason, deferred endoscopic realignment is considered an adequate substitute because urethral continuity can be achieved in a group of patients without increase incidence of impotence and incontinence
Management of traumatic posterior urethral disruption is still divided between 2 lines of treatment
The classic approach consists of delayed repair, which entails a suprapubic cystostomy at the time of injury and delayed perineal approach urethral reconstruction 4–6 months after injury [1]
Summary
Management of traumatic posterior urethral disruption is still divided between 2 lines of treatment. The classic approach consists of delayed repair, which entails a suprapubic cystostomy at the time of injury and delayed perineal approach urethral reconstruction 4–6 months after injury [1]. Occurs in almost all patients treated initially with suprapubic cystostomy. Some experts believe that this approach subjects the patient to a major operation at a critical time and provides little benefit for the effort expended [13]. Early urethral realignment for traumatic complete posterior urethral disruption is generally encouraged to prevent intractable urethral stricture [2,14]
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