Korean J Urol.  2007 Nov;48(11):1165-1170. 10.4111/kju.2007.48.11.1165.

5 Year Follow-up Results of Endoscopic Primary Realignment in Urethral Injury

• Park CS
• Park SW
• Kim JM
• Lee JZ

• KMID: 1997095
• DOI: http://doi.org/10.4111/kju.2007.48.11.1165

Abstract

PURPOSE: The standard management of posterior urethral injury is controversial with regard to immediate primary realignment versus delayed urethroplasty. We analyzed the long-term results of treatment for urethral injury with performing immediate primary realignment.
MATERIALS AND METHODS
19 patients with urethral injury were treated by endoscopic primary realignment from March 2000 to March 2002. Anterior and posterior urethral injuries were classified into the A and P groups, respectively, and the A and P groups had 11 and 8 patients, respectively. We investigated 5-years of follow-up complications, which were composed of urethral stricture, incontinence and impotence. The mean follow-up period was 69.8 months after injury, and the follow-up status was obtained from a patient questionnaire or a telephone interview.
RESULTS
6(75%) of the P group had post-realignment stricture. However, 2 patients(25%) were considered to have mild strictures that were easily managed with a urethral sound, and 4(50%) had more significant stricture that required visual internal urethrotomy(VIU). 2(18%) of the A group needed only a sound and 4(36%) were managed via VIU. 1(13%) of the P group reported mild stress incontinence, but the patient did not need padding. 6(75%) of the P group had no erectile dysfunction, 1(13%) reported a decreased quality of erection that required only oral phosphodiesterase 5 inhibitor and 1(13%) required intracavernosal injection therapy.
CONCLUSIONS
Endoscopic primary realignment of urethral injury is a simple, safe, rapid and nontraumatic technique. It reduces the incidence and extent of the complications such as stricture, erectile dysfunction and incontinence. Therefore, we recommend this endoscopic primary realignment for the initial management of posterior urethral injury, as well as for anterior urethral injury.

Keyword

Endoscopy; Urethra; Injury

MeSH Terms

Constriction, Pathologic
Cyclic Nucleotide Phosphodiesterases, Type 5
Endoscopy
Erectile Dysfunction
Follow-Up Studies*
Humans
Incidence
Interviews as Topic
Male
Questionnaires
Urethra
Urethral Stricture
Cyclic Nucleotide Phosphodiesterases, Type 5

Reference

1. Lee YT. Urethral injury. Korean J Urol. 2006. 47:221–231.

2. Kal WJ, Moon YT, Kim SC. Endoscopically guided primary urethral realignment as a treatment of anterior urethral rupture. Korean J Urol. 1996. 37:794–797.

3. Follis HW, Kock MO, McDougal WS. Immediate management of prostatomembranous urethral disruptions. J Urol. 1992. 147:1259–1262.

4. Husmann DA, Wilson WT, Boone TB, Allen TD. Prostatomembranous urethral disruptions: management by suprapubic cystostomy and delayed urethroplasty. J Urol. 1990. 144:76–78.

5. Goldman SM, Sandler CM, Corriere JN Jr, McGuire EJ. Blunt urethral trauma: a unified, anatomical mechanical classification. J Urol. 1997. 157:85–89.

6. Pontes JE, Pierce JM Jr. Anterior urethral injuries: four years of experience at the Detroit General Hospital. J Urol. 1978. 120:563–564.

7. Jeong CS, Seo IY, Park SC, Oh SJ, Rim JS. The success rate and complications of the primary endoscopic urethral realignment within 3 days in male urethral injury. Korean J Urol. 2004. 45:1039–1043.

8. Ying-Hao S, Chuan-Liang X, Xu G, Guo-Qiang L, Jian-Guo H. Urethroscopic realignment of ruptured bulbar urethra. J Urol. 2000. 164:1543–1545.

9. Cohen JK, Berg G, Carl GH, Diamond DD. Early endoscopic realignment following posterior urethral disruption. J Urol. 1991. 146:1548–1550.

10. Melekos MD, Pantazakos A, Daouaher H, Papatsoris G. Primary endourologic re-establishment of urethral continuity after disruption of prostatomembranous urethra. Urology. 1992. 39:135–138.

11. Yasuda K, Yamanishi T, Isaka S, Okano T, Masai M, Shimazaki J. Endoscopic re-establishment of membranous urethral disruption. J Urol. 1991. 145:977–979.

12. Elliott DS, Barrett DM. Long-term followup and evaluation of primary realignment of posterior urethral disruptions. J Urol. 1997. 157:814–816.

13. Gheiler EL, Frontera JR. Immediate primary realignment of prostatomembranous urethral disruptions using endourologic techinques. Urology. 1997. 49:596–599.

14. Morehouse DD, Belitsky P, MacKinnon K. Rupture of the posterior urethra. J Urol. 1971. 63:11–14.

15. Webster GD, Mathes GL, Selli C. Prostatomembranous urethral injuries: a review of the literature and a rational approach to their management. J Urol. 1983. 130:898–902.

16. Koraitim MM. Pelvic fracture urethral injuries: evaluation of various methods of management. J Urol. 1996. 156:1288–1291.

17. Mouraviev VB, Coburn M, Santucci RA. The treatment of posterior urethral disruption associated with pelvic fractures: comparative experience of early realignment versus delayed urethroplasty. J Urol. 2005. 173:873–876.

18. Kotkin L, Koch MO. Impotence and incontinence after immediate realignment of posterior urethral trauma: result of injury or management? J Urol. 1996. 155:1600–1603.

19. Jepson BR, Boullier JA, Moore RG, Parra RO. Traumatic posterior urethral injury and early primary endoscopic realignment: evaluation of long-term follow-up. Urology. 1999. 53:1205–1210.

20. Kielb SJ, Voeltz ZL, Wolf JS. Evaluation and management of traumatic posterior urethral disruption with flexible cystourethroscopy. J Trauma. 2001. 50:36–40.

21. Moudouni SM, Patard JJ, Manunta A, Guiraud P, Lobel B, Guille F. Early endoscopic realignment of post-traumatic posterior urethral disruption. Urology. 2001. 57:628–632.

22. Gibson GR. Impotence following fractured pelvic and ruptured urethra. Br J Urol. 1970. 42:86–88.

23. Mundy AR. The role of delayed primary repair in the acute management of pelvic fracture injuries of the urethra. Br J Urol. 1991. 68:273–276.

24. Oh SJ, Rim HK, Rim JS. Results of primary endoscopic urethral realignment as a treatment of urethral injury according to the injury site. Korean J Urol. 1999. 40:1425–1429.