Immediate endoscopic management of complete iatrogenic anterior urethral injuries: A case series with long-term results

Abstract

BackgroundUrethral injury produces partial or complete disruption of the urethral integrity. Advances in endourology have made endoscopic management of most of these injuries feasible without greatly compromising the final result. We report our institutional experience of immediate endoscopic realignment of complete iatrogenic anterior urethral injury.MethodsFrom May 1997 to May 2003, seven patients with complete anterior urethral disruption were managed by immediate endoscopy guided splinting of urethra. Retrograde urethroscopy, combined with fluoroscopic guidance and in some cases antegrade cystoscopy through a suprapubic stab cystostomy was performed. A guide wire was negotiated across the disruption. Later, a 16 F Foley catheter was placed for 1–3 weeks. Patients were followed up at 1, 3, 6 and 12 months and then yearly to assess the long-term outcome of endoscopic management.ResultsImmediate endoscopic realignment was achieved in all patients. Three patients developed recurrence at six months; that was treated by optical urethrotomy. Only one patient developed multiple recurrences over an average follow-up of 49.2 months (range 7 to 74 months). He was offered open end-to-end urethroplasty at twenty months after third recurrence. Thus immediate endoscopic realignment avoided any further intervention in four patients (57.14%); while after an additional optical urethrotomy, urethroplasty could be avoided in six patients (87.2%).ConclusionImmediate endoscopic realignment of traumatic urethral disruption is a feasible, safe and effective treatment modality for management of patients with iatrogenic complete anterior urethral injuries.

Early endoscopic realignment of traumatic anterior and posterior urethral disruptions under caudal anaesthesia – a 5-year review

“…We recently described a procedure for early endoscopic realignment of ruptured posterior urethras using the rigid Sache urethrotome under regional anaesthesia in the outpatient endoscopy unit (15). Similar to others (13,14), we have found the operation useful for anterior urethral disruptions as well, and as such it is now the treatment of choice for all urethral injuries that present acutely to our institution. We now present our 5‐year experience with this procedure in our institution.…”

“…It is, however, associated with a high postoperative stricture rate, although most are amenable to either urethrotomy or dilation (11,12). Patients with recurrent strictures are placed on a regime of clean intermittent self‐calibration (CIC) or offered urethroplasty (5,8,11,13,14).…”

Patterns of urethral injury and immediate management

“…As a result, several institutions have attempted to treat these injuries by primary realignment with the hope that the rate of urethral stricture will decrease. Maheshweri and Shah [29] reported their experience with iatrogenic urethral injuries in patients with complete anterior urethral disruption who were managed by immediate endoscopic-guided splinting of the urethra. Retrograde urethroscopy combined with fluoroscopic guidance and in some cases antegrade cystoscopy through a suprapubic stab cystostomy was performed.…”

Multidetector Computed Tomography of Iatrogenic Urinary Trauma - Pictorial Review

“…Urethral rupture occurs rarely, usually during iatrogenic procedures due to bladder catheterisation or urethral dilatation, sometimes also resulting from inflating a Foley balloon in the urethra [12]. It clinically presents with acute urinary retention and/or bleeding per urethra.…”