Should primary realignment become the standard line of treatment for traumatic posterior and bulbar urethral disruption?

Abstract

Objectives: To assess early urethral realignment and the correlation of severity of pelvic fracture, with impact of technique on continence and potency. Methods: Prospective analysis on patients of post traumatic urethral disruption from 7/2013–5/2015 at Cairo University hospitals. Initial management entailed suprapubic tube insertion. Antegrade flexible cystoscopy or rigid ureteroscopy via the suprapubic access, together with retrograde rigid cystoscopy and real-time fluoroscopy. Follow up entailed history taking, uroflowmetry, urethrograms, cystoscopy, success rate, continence, erectile status after trauma and need for auxiliary procedures after catheter removal. Results: A total of 18 men with a mean age of 27 ± 15 years. Endoscopic realignment (ER) was performed in 15 out of 18 patients. Open realignment was done in 3 cases. Mean OR time for ER was 30 ± 22 min. Estimated blood loss was minimal. Mean time from injury to primary realignment was 6.0 ± 3.8 days. We found a good correlation between presence of pelvic fracture and grade of urethral injury, but no correlation was found between Tile class and grade of urethral injury. A total of 9 (56.3%) out of 16 patients, who completed follow-up developed 2ry strictures. 6 had narrowing of the urethra and underwent DVIU; 2 of whom had recurrent stricture and needed urethroplasty. 3 had complete obliteration of the urethral lumen and definitive urethroplasty was done. Mean follow up duration 20.6 ± 5.3 months. No patient suffered from UI and only 1 out of 13 adult patients who completed follow up (7.7%) suffered ED. Conclusions: Early urethral realignment is successful due to advances in endoscopic techniques. Keywords: Realaignment, Endoscopic, Posterior urethra, Traumatic disruption