Comparative results of the treatment of post-traumatic ruptures of the posterior urethra by endoscopic realignment and surgery

Objective: Retrospective, comparative study of the long-term results of end oscopic realignment and surgery in the treatment of complete rupture of the posterior urethra. Material and Methods: Between 1989 and 1998, 40 men were managed for trauma tic posterior rupture of the membranous urethra: 30 were treated by endosco pic realignment for complete rupture while 10 were treated by surgery (peri neal or transsymphyseal incision) for a long stenosis (>3 cm) secondary to extensive rupture of the urethra. Results: With a mean follow-up of 30 months (12 to 72 months), all patients treated by endoscopic realignment are continent and urinate with a satisfa ctory urine output (Qmax greater than or equal to 15 ml/s). This result was obtained after internal urethrotomy in 7 patients (23.33%) and transperine al urethroplasty in one patient. Six patients developed persistent impotenc e (20%). For the ten patients treated surgically, the voiding stream was co nsidered to be satisfactory (Qmax > 15 ml/s in 6 patients while 4 developed short strictures accessible to endoscopic urethrotomy. Nine patients are c ontinent, while one completely incontinent patient with perineal fistulas r equired a continent cystostomy. Four our of 10 patients reported sexual imp otence. Conclusion: Endoscopic realignment of complete rupture of the membranous ur ethra is a simple, minimally aggressive technique, ensuring optimal preserv ation of continence and sexuality in young subjects.