The Success Rate and Complications of the Primary Endoscopic Urethral Realignment within 3 Days in Male Urethral Injury

Jeong, Chan Sang; Seo, Ill Young; Park, Seung Chol; Oh, Sang Jin; Rim, Joung Sik

Abstract

PURPOSE: Attempts have been made to insert a urethral Foley catheter as a primary urethral realignment immediately after a urethral injury. There has been much debate about the time and method of the realignment. The feasibility and complications of early primary endoscopic realignment in a urethral injury were evaluated.
MATERIALS AND METHODS
From November 1990 to May 2003, 63 patients with urethral injuries received early endoscopic realignment within 72hrs. The diagnosis was made by retrograde urethrography. Primary realignment was successfully performed for 61 patients; 52 (85.2%) had an anterior urethral injury and 9 (14.8%) a posterior urethral injury. All operations were performed under spinal anesthesia. A cystoscope was inserted through the dilated suprapubic cystotomy and a guide wire passed through the cystoscope, and caught by transurethral foreign body forceps just distal to the injured site. The urethral catheter was removed after pericatheter urethrography, usually on the 14th postoperative day. Patients were retrospectively reviewed for complications, including urethral stricture, urinary incontinence and erectile dysfunction.
RESULTS
Of the 63 patients, 61 (96.8%) were successfully treated. The mean operation and catheter indwelling times were 71.8 minute (5-109) and 17.4 days (6-32), respectively. The mean follow-up duration was 423.2 days (94-1432). Urethral strictures were detected in 14 patients (23.0%), who were treated with an internal urethrotomy. Urinary incontinence in 5 patients (8.2%) and erectile dysfunction in 14 patients (23.0%) were the observed complications.
CONCLUSIONS
Our results show that immediate endoscopic realignment is a less invasive and more feasible therapy for patients with a urethral injury.