Immediate management of posterior urethral disruption associated with pelvic fracture: early experience

ABSTRACT

Urethral reconstruction of the patient with severe mechanical trauma remains controversial and require some of the most challenging techniques in urologic surgery. Early realignment and posterior urethral reconstruction can be done in a single stage with direct bulbo-membranous anastomosis. Herein we review our early experience in immediate management of post-traumatic posterior urethral disruption. Between January, 1999 and July, 2004, 24 patients underwent immediate management after severe blunt pelvic injury with posterior urethral disruption. All patients were males with age range from 4-65 years [mean 27.75]. Immediate open urethroplasty was performed with a perineal approach in all patients. All patients were evaluated post-operatively for incontinence, impotence and urethral strictures from 1-4 years. The results were successful in 16 patients [66.7%] for up to 4 years. Urinary incontinence did not develop in any patients, while impotence developed in 6 patients [25%] due to trauma itself and not due to anastomotic surgery. We advice immediate management of posterior urethral disruption secondary to blunt pelvic injury in the stable trauma patient, as it provide good outcomes with a lower stricture rate [33.3%] especially if it is compared with other international results of such reconstructive surgery