Early endoscopic realignment as primary therapy for complete posterior urethral disruptions.

Abstract

We assessed the outcome of early endoscopic realignment of posterior urethral disruptions. We evaluated six patients who underwent early or delayed endoscopic realignment for the disrupted posterior urethra over a 3-year period. C-Arm fluoroscopy guidance and orientation in two planes were used as necessary. Potency, restructure rates, and continence were assessed in addition to hospital length of stay, intraoperative blood loss, and uroflow. The collective results of ten publications were also reviewed. In the present study, all of the six patients were continent. One had diminished erectile capability, and four required subsequent internal urethrotomies. Evaluation of the cumulative data (including the present study) showed an overall 9% incontinence rate, 60% potency rate, and 54% restricture rate. Endoscopic realignment of the disrupted posterior urethra is a minimally invasive procedure with results comparable to those of open delayed urethroplasty. Early and delayed repairs have been applied with similar results, the former being advocated in patients who are medically and orthopedically stable. Hospital stay, loss of work, morbidity, and related complications are also markedly decreased with early endoscopic realignment.