Rupture of the male membranous urethra

Background Management of traumatic rupture of the male membranous urethra r emains controversial. Long-term morbidity can include urinary incontinence, urethral stricture and erectile dysfunction. Aims To review management and outcome of urethral rupture to improve treatm ent protocols. Methods A retrospective study of 47 patients presenting with traumatic uret hral rupture over 25 years was performed. Results All patients underwent emergency suprapubic catheterisation, 32 pat ients had open surgical realignment at 1-2 weeks; 78% of whom developed str ictures. Ten patients unsuitable for early repair underwent delayed transab dominal transpubic urethroplasty at three months: 40% of whom developed str ictures. Five patients with partial rupture were managed by cystoscopy and urethral catheter. Erectile dysfunction correlated to initial injury rather than treatment. Conclusions If the patient is stable and requires emergency laparotomy for other abdominal injuries, he should have immediate realignment of the ureth ra. Early realignment of the urethra at laparotomy at 1-2 weeks can be comb ined with orthopaedic fixation of pelvic fractures. Patients who remain uns table due to associated injuries should have delayed urethroplasty at three months.