Ten Years Experience of Post-Traumatic Complete Urethral Stricture Treated with Endoscopic Internal Urethrotomy

Byun, Jae Sang; Song, Jae Mann

Abstract

We reviewed our experience retrospectively with 65 patients who had post-traumatic complete urethral stricture secondary to pelvic bone fracture or other causes during last 10 years. All patients underwent delayed endoscopic internal urethrotomy (EIU) 3 to 9 months later after immediate suprapubic diversion. Prior to EIU, the antegrade-retrograde urethrogram demonstrated a complete urethral disruption, and the length of urethral obstruction was measured from 0.5cm to 3.5cm (mean 1.4cm). Of 65 patients, 61 patients (94%) had successful operations, 4 patients (6%) whose strictures were measured more than 2.5cm were failed and treated with open urethroplasty. Sixty-one patients who eventually underwent successful endoscopic internal urethrotomy; 28 patients (46%) achieved satisfactory urethral voiding after first EIU; 33 patients (54%) took operations more than twice due to recurred partial urethral stricture. After 6 to 53 months (average-21months), fifty-six (86%) of 65 patients voided satisfactorily (incontinence in 3 patients). Five patients who did not void well even after successful EIU were diagnosed to have neurogenic bladder (detrusor areflexia). Of 65 patients, 16 patients (25%) had post-traumatic impotence. After the EIUs were performed, there were no newly developed impotences. There were no serious major complications. We concluded that direct visual internal urethrotomy was useful and safe as a primary minimally invasive therapeutic modality for post-traumatic complete urethral stricture in selected patients with relatively short urethral defect (less than 2.5cm).