Early Endoscopic Realignment of Traumatic Anterior and Posterior Urethral Disruptions under Caudal Anaesthesia - A 5-Year Review

SUMMARY

Objective: We recently described early rigid retrograde endoscopic realignment of the disrupted urethra under caudal anaesthesia in the outpatient setting. This retrospective study was performed to evaluate our medium-term results. Patients and methods: A retrospective review of patients who had early rigid retrograde endoscopic realignment of traumatic urethral disruptions in our institution over a 5-year period was done and the relevant data extracted and analyzed. Results: Fourteen acutely ruptured urethras (10 posterior and four anterior) were endoscopically realigned early in the' study period. Nine (90%) of the posterior disruptions occurred at bulbo-membranous urethra (distal to the external sphincter mechanism). Thirteen of the ruptured urethras (93%) were successfully realigned? (nine posterior and four anterior) and postoperative clean intermittent seH-calibration ((I() was instituted in 1O.patients. The mean follow-up period was 36.6 months (range 18-54 months). The mean operating time and the median hospital stay were 22 min (range 8-68 min) and 3 days (range 1-10 days), respectively, and were shorter in patients with injuries of the anterior urethra than those with posterior urethral tears (p s 0.0001). Post-realignment, all 13 patients were potent and continent. Two patients required additional procedures (direct vision internal urethrotomy or urethral dilation) and one patient has remained on (I( i.e. a stricture rate of 21%. Conclusion: Early retrograde endoscopic realignment under caudal analgesia is suitable and cost-effective for patients with acute traumatic urethral disruptions and has good medium-term results. In addition. an early postoperative regimen of (Ie significantly reduced stricture-formation in our series.