Korean J Urol.  2012 Aug;53(8):569-572.

Comparison of Immediate Primary Repair and Delayed Urethroplasty in Men with Bulbous Urethral Disruption after Blunt Straddle Injury

• Gong IH
• Oh JJ
• Choi DK
• Hwang J
• Kang MH
• Lee YT

Abstract

PURPOSE
The aim of this study was to analyze the outcomes of immediate primary repair (IPR) compared with delayed repair (DR) after initial suprapubic cystostomy.
MATERIALS AND METHODS
We reviewed the records of 60 patients with bulbous urethral disruption after blunt trauma from February 2001 to March 2011. Seventeen patients who presented in an acute injury state underwent IPR; 43 patients underwent DR after the initial suprapubic cystostomy. None of the patients had undergone previous urethral manipulation. We compared the outcomes, including stricture, impotence, and incontinence, between the two management approaches. We also measured the time to spontaneous voiding, the duration of suprapubic diversion, and the number of days spent in the hospital.
RESULTS
The median follow-up was 20.5 months (range, 13 to 59 months; mean, 23.3 months). Among 17 patients in the IPR group, strictures developed in 2 patients (11.7%), and among 53 patients in the DR group, strictures developed in 8 patients (18.6%, p=0.709). The incidences of impotence and incontinence were similar in both groups (17.6% and 0% in the IPR group vs. 27.9% and 4.6% in the DR group, p=0.520 and 1.000, respectively). The time to spontaneous voiding and the duration of suprapubic diversion were significantly shorter in the IPR group (average 27.3 and 33.4 days, respectively) than in the DR group (average 191.6 and 198.1 days, respectively; p<0.001 and <0.001).
CONCLUSIONS
IPR may provide comparable outcomes to DR and allow for shorter times to spontaneous voiding and reduce the duration of suprapubic diversion.

Keyword

Urethra; Urethral stricture; Urologic surgical procedures; Wounds and injuries

MeSH Terms

Constriction, Pathologic
Cystostomy
Erectile Dysfunction
Follow-Up Studies
Humans
Incidence
Male
Urethra
Urethral Stricture
Urologic Surgical Procedures

Figure

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  FIG. 1 Stricture-free rate at the end of 3 years according to management type (dotted line, immediate primary repair; solid line, delayed repair).

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