Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experience

Abstract

Introduction:The optimal management strategy for urethral injuries remains controversial. Suprapubic cystostomy followed by delayed urethral reconstruction or immediate primary urethral injury repair is associated with high complication rate. Early endoscopic realignment for urethral injuries provides early definitive procedure with low complications and avoids the need for further urethral reconstruction.Materials and Methods:Between April 2007 and March 2016, 27 patients with traumatic posterior urethral disruptions were reviewed. All patients were managed by endoscopic urethral realignment. Patients were followed up every 3 months for 18–36 months regarding incontinence, potency, and urine flow.Results:Endoscopic urethral realignment was performed immediately in 21 patients and was delayed in 6 patients. It was successful in 24/27 (88.8%) patients. During the procedure, the proximal urethral end was identified directly in four patients, and by the guidance of methylene blue injection, guidewire or endoscopic light in three, nine, and eight patients, respectively. The Foley catheter was removed after 9 weeks in 17/24 (70.8%) patients and after 12 weeks in 7/24 (29.2%) patients. Six months after realignment, minimal urethral stricture was developed in 4/24 (16.7%) patients. All of them were treated successfully with single session of internal urethrotomy without recurrence after 1-year follow-up. After 18–36-month follow-up period, all patients were potent, continent, and with satisfactory voiding pattern.Conclusions:Endoscopic primary realignment of posterior urethral rupture is less invasive and a safer procedure, without pelvic hemorrhage or additional injuries. It has low incidence of severe urethral stricture and avoids the need for delayed open urethral reconstruction.

Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians

“…Once a stricture has formed, it can be surgically managed with urethrotomies, which are an endoscopic opening of the scar internally, or repeated dilations [ 6 , 36 , 37 ]. In circumstances involving iatrogenic prostatic urethral strictures, endoscopic management is preferred to indwelling catheter placement or an open procedure [ 37 ]. Lastly, urethroplasty is suggested for urethral lesions following radiotherapy [ 2 , 38 , 39 ].…”

“…The Seldinger Technique is then employed to place a urethral catheter across the disruption to achieve continuity [ 45 , 47 ]. Recent literature indicates that PER is simple, safe, rapid, and nontraumatic, reducing urethral injury compared to the open approach [ 37 ]. Defects that are up to 2 cm in size within the bulbar urethra and up to 1.5 cm in size within the penile urethra may be repaired with primary direct anastomosis; however, repair of larger defects should be deferred until a later date to allow for proper planning of tissue transfers [ 48 ].…”

“…A total of 5% to 25% of males who have a pelvic fracture will have a PFUI stemming from blunt trauma [ 37 ]. Thus, amongst patients with membranous urethral injuries related to blunt trauma, almost all have an associated pelvic fracture [ 6 ].…”

Early primary endoscopic realignment in children with posterior urethral and bladder neck injury

“…It reduces the incidence and extent of the complications such as stricture and incontinence. El Darawany [21] noted that primary endoscopic realignment seems to lessen the severity of stricture disease and the need for delayed reconstructive urethral surgery and decreased its associated morbidity. Primary endoscopic realignment if failed, it neither delays nor precludes further management using open techniques.…”

A Modified Endoscopic Primary Realignment of Severe Bulbar Urethral Injury

“…EER may pose no disadvantage to erectile function and continence due to the lack of additional trauma to periprostatic tissues and cavernous nerves. 39 Furthermore, some researchers also observed that ED did not differ significantly between STDU and EER. [40][41][42] Other notable complications include further urethral injury as well as an increased incidence of infection, however, none of these were observed in our study.…”