Clinical evaluation of cases of lower genitourinary tract trauma with special reference to primary realignment in cases of posterior urethral distraction defect

ABSTRACT

Background: The exact management strategy for lower genitourinary tract trauma remains controversial. Primary realignment with/without suprapubic catheterization provides definitive procedure with low complications and avoids the need for further open surgeries.Methods: This was a prospective longitudinal study done on 31 cases with different complaints related to lower tract genitourinary trauma. All patients underwent suprapubic catheterization and/or primary realignment. The outcome was measured in the terms of time for discharge, urinary incontinence, stricture formation, erectile dysfunction and impotence.Results: Maximum proportion of patients with lower genitourinary injuries in the study was in 10-20 years age group (48.4%). Blunt trauma was accounted for 93.6% of lower genitourinary injuries. Road traffic accidents were the most common cause (90.32%) of lower genitourinary injuries. Urinary bladder injuries accounted for 41.9% of all lower genitourinary injuries. Blood at meatus is present in only about half of the significant urethral injuries. Primary realignment of urethral injury results in lesser duration of hospital stay (9.24±2.44 days), shorter length of suprapubic catheterization (11.67±4.78 days) and early spontaneous voiding (40.93±15.79 days). The stricture rate following primary realignment is low (31.25%). Erectile dysfunction was noted only in two patients (16.6%).Conclusions: Management of traumatic urethral disruption by primary realignment serves as ultimate therapy in majority of patients.