Above and Below Delayed Endoscopic Treatment of Traumatic Posterior Urethral Disruptions

Abstract

Between 1982 and 1990, 10 men with posterior urethral obliterations associated with pelvic fracture were managed with delayed above and below endoscopic reconstruction. After a mean of 43 months (range 7 to 108) of followup, all 10 men void with a peak flow rate of 12 ml. per second or greater and/or have a urethral caliber of 20F or greater. Concomitant prostatic hypertrophy somewhat compromises micturition in 4 older men. Nine patients are totally continent and 1 has mild stress incontinence. Five men who were potent after injury remain so after reconstruction. Of the 10 patients 6 required subsequent visual urethrotomy and/or scar resections, generally as outpatient or short stay procedures. In most instances voiding stabilized within 1 year, and interventions after this interval were unusual and generally trivial. We compare our experience with the results of others using a similar delayed endoscopic approach and conclude that this is a satisfactory method of managing traumatic posterior urethral obliterations, resulting in satisfactory voiding, continence and potency preservation.

Pelvic fracture urethral injury in males—mechanisms of injury, management options and outcomes

“…There is a 19% failure rate for initial attempt at DVIU; all such failures will require a core-through procedure ( 20 ). Eventual RS is almost inevitable at 95.8–100% ( 20 , 21 , 196 , 197 ) with 39–41.8% requiring urethroplasty at a follow-up of 24–43 months.…”

“…Complications associated with delayed endoscopic management of PFUI stricture include primary and secondary haemorrhage, urinary tract infection and extravasation of irrigating fluids ( 20 , 22 ). Evaluating all techniques of delayed endoscopic management RS occurs in @80% ( 27 , 143 , 192 , 195 , 199 , 202 - 219 ), ED in @32% (range, 0–64%) and UI in @4% (0–40%) ( 8 , 20 - 22 , 138 , 164 - 166 , 180 , 196 - 198 , 202 - 205 , 207 - 210 , 211 , 213 , 215 - 217 ) ( Table 6 ).…”

Erectile dysfunction in relation to traumatic pelvic injuries or pelvic fractures

“…This procedure is especially suitable for strictures < 3 cm long. Erectile function was preserved in 97% of patients who had good function before the procedure [54]. Other authors prefer a delayed primary urethral repair a few days after the injury.…”

The management of the acute setting of pelvic fracture urethral injury (realignment vs. suprapubic cystostomy alone)

“…The goal of management is to realign the urethra whilst minimising the risks of ED, incontinence and subsequent urethral stricture [4] ; Table 1 [13–41] and Fig. 1 summarise the findings of the above complications in early endoscopic realignment (EER), early open primary realignment, and STDU in studies from 1990 to the present.…”