The Value of Immediate or Early Catheterization of the Traumatized Posterior Urethra

Abstract

A total of 16 patients with posterior urethral ruptures was treated with the aim of reestablishing urethral continuity immediately or early after injury. Followup ranged from 13 to 83 months (average 27), In all patients an emergency retrograde urethrogram demonstrated extravasation from the posterior urethra. Of the patients 13 were treated with a urethral catheter either immediately or within 1 to 5 weeks after injury. Three patients were treated with a suprapubic catheter alone after unsuccessful attempts at reestablishing urethral continuity and all 3 subsequently required urethroplasty for an obliterative stricture. These 3 patients were also impotent after injury. Of the 13 patients treated with a urethral catheter 8 had the catheter inserted either retrograde (2) in the emergency room or antegrade (6) in the operating room just after the injury, and in 5 the catheter was inserted transurethrally at cystoscopy within a mean of 3 weeks after injury. A total of 7 patients (54%) treated with urethral catheterization had a stricture during followup: 4 responded well to internal urethrotomy and 3 required simple dilation. Of 12 patients 5 (42%) became impotent after injury, while 1 was impotent before injury. No patient became incontinent. We conclude that careful urethral catheter realignment either immediately or within 5 weeks after injury is safe and obviates total urethral closure. Impotence may result from the severity of the injury and not from management with catheterization.