Treatment of Impotence Resulting from Internal Urethrotomy

Abstract

A complication of internal urethrotomy (11% in 1 series') is impotence caused by a corpus cavernosum-spongiosum fistula. We report a novel perineal approach to fistula repair. CASE REPORT A 44-year-old man experienced a straddle injury at work, and presented with urethral bleeding and perineal pain. Retrograde urethrography demonstrated a small amount of extravasation into the corpus spongiosum without contrast medium reaching the bladder. A urethral catheter could not be passed, direct endoscopic visualization failed to identify urethral continuity and a suprapubic tube was placed. Two months following the injury retrograde urethrography demonstrated a 1 cm. bulbar urethral stricture, which was dilated. Cold-knife direct vision internal urethrotomy was performed at the 12 o'clock position. The patient subsequently voided well with a normal flow rate but complained of erections inadequate for intercourse, which had been normal before direct vision internal urethrotomy. Impotence evaluation, including duplex Doppler cavernosometric tests, demonstrated high maintenance flow rates and low cavernous artery pressures and flow. Radiography of the cavernosa revealed a fistula between the corpus cavernosum and corpus spongiosum in the area of the urethrotomy (fig. 1).