Surgical treatment of traumatic rupture of the posterior urethra.

Objectives: To compare the therapeutic results of deferred urgent surgical treatment and late treatment of traumatic ruptures of the posterior urethra . Material and Method: 35 patients with a mean age of 25 years (range: 7 to 7 9 years) were operated for trauma of the posterior urethra. In most cases, trauma was secondary to a road accident, associated with fracture of the pe lvis. When rupture of the posterior urethra was diagnosed, the subsequent m anagement depended on the patient's general condition and associated lesion s. In the absence of serious skeletal or visceral lesions, the patient was operated within 3 weeks following trauma, after radiological assessment. Th is approach was applied in 16 patients (Group I). The other 19 patients (Gr oup II) were only operated at the sixth month, after stabilization of all t raumatic lesions. Results: Results were assessed in terms of the quality of the urinary strea m, urinary continence and sexual impotence. The stream was considered to be good in 93.75% of cases (Group I) and 78.8% of cases (Group II). Continenc e was perfect in 100% of cases (Group I), versus 89.4% (Group II) and sexua l impotence was observed in 18.7% (Group I) versus 5.3% (Group II). Conclusion: Trauma of the posterior urethra, without any serious associated lesions, can be operated as a deferred emergency with excellent results in terms of voiding (80% of good results), but with a higher frequency of sex ual impotence. In patients with serious associated lesions, the therapeutic management of the urethral trauma is performed after an interval of 3 to 6 months, at the stage of urethral stricture. In this case, surgery consists of resection of the fibrous callus, followed by urethral anastomosis. The results of this operation are good, at the cost of repeated stricture, trea ted endoscopically, but with a lower incidence of sexual impotence.