Early endoscopic realignment of post-traumatic posterior urethral disruption

Objectives. The management of complete or partial urethral disruption is co ntroversial, and much debate continues regarding immediate versus delayed d efinitive therapy, We further analyze our experience and long-term results using early endoscopic realignment. Methods. Between April 1987 and January 1999, 29 men with posterior urethra l disruption (23 complete and 6 partial) underwent primary urethral realign ment 0 to 8 days after injury. Pelvic fractures were present in 23 patients . In all patients, the actual operating time for realignment was 75 minutes or less. All patients were evaluated postoperatively for incontinence, imp otence, and strictures. Results. After a mean follow-up of 68 months (range 18 to 155), all patient s were continent. Four patients (13.7%) required conversion to an open peri neal urethroplasty. At the last follow-up visit, 25 (86%) of the 29 patient s were potent and 4 achieved adequate erections for intercourse using intra corporeal injections (prostaglandin E-1). Twelve patients (41%) developed s hort secondary strictures and were successfully treated with internal ureth rotomy. The mean follow-up of these 12 patients was 83 months (range 34 to 120). Urinary flow rate measurement at the last follow-up visit revealed sa tisfactory voiding parameters in all patients. Conclusions. Primary endoscopic realignment offers an effective method for treating traumatic urethral injuries. Our long-term follow-up provides addi tional support for the use of this technique by demonstrating that urethral continuity can be established without an increased incidence of impotence, stricture formation, or incontinence. In case of failure, endoscopic reali gnment does not compromise the result of secondary urethroplasty. UROLOGY 5 7: 628-632, 2001. (C) 2001, Elsevier Science Inc.