Endoscopic realignment versus delayed urethroplasty in the management of post traumatic urethral disruption: Report of 30 cases

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Published May 24, 2013
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Vol. 91 No. 5 (2013): Issue May 2013

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Rami Boulma
Yosri Kallel
Ahmed Sellami
Mohamed M Gargouri
Sami B. Rhouma
Mohamed Chlif
Zouhaier Fitouri
Ali Horchani
Yassine Nouira

Abstract

Background: Post traumatic posterior urethral disruption is a common condition, its treatment is controversial.
aim: To assess the long term results of endoscopic realignment compared with delayed urethroplasty, in the management of post traumatic urethral disruption.
methods: Between February 2002 and March 2009, 30 patients have been operated for post traumatic posterior urethral disruption. 20 have had a primary endoscopic realignment and 10 have had delayed urethroplasty. Analysis of the results took into consideration, the quality of micturition, the continence and the erectile function.
results: Median follow-up was 21 months, good results were recorded in 13 patients among the group of realignment (65%). 0f the failure cases (7), 3 underwent urethroplasty and 4 were managed by endoscopic treatment. Endoscopic realignment could avoid open surgery in 17 patients (85%). Among the 10 patients that underwent urethroplasty, 7 patients had good results (70%). No patient had urinary incontinence. A post operative erectile dysfunction was noted in one patient from the realignment group and two other patients from the urethroplasty group.
Conclusion: The endoscopic urethral realignment could be used as a primary therapeutic management of post traumatic urethral disruption. It could be recommended for recent trauma, between one and two weeks, and for patients that can support exaggerated lithotomy position. Endoscopic realignment is an effective safe therapeutic mean that does not contraindicate a second-line urethroplasty.

Keywords:

Posterior urethra, post traumatic disruption, endoscopic realignment.

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