THE IMPORTANCE OF ACCURATE ASSESSMENT AND CONSERVATIVE MANAGEMENT OF THE OPEN BLADDER NECK IN PATIENTS WITH POST-PELVIC FRACTURE MEMBRANOUSURETHRAL DISTRACTION DEFECTS

Objective To review the pre-operative assessment of bladder neck compe tence and assess the success of non-operative management of the bladde r neck in patients with pelvic fracture membranous urethral distractio n defects. Patients and methods A series of four patients with long-st anding post-pelvic fracture urethral distraction defects and open blad der necks demonstrated on preoperative investigation are presented. Re sults All four patients were managed by perineal urethroplasty without surgery to the bladder neck. All patients were continent post-operati vely despite the injury having ablated the distal sphincter mechanism. Conclusion We believe that the majority of patients can be managed su ccessfully by a non-operative approach to the bladder neck, sparing th em the unnecessary operative morbidity of an abdomino-perineal repair, which should be reserved for those with obviously scarred or distorte d bladder necks.