Early Urethroscopic Realignment of Ruptured Bulbous Urethra

Abstract

Purpose: To evaluate the efficacy of early urethroscopic realignment compared to initial suprapubic cystostomy in the management of bulbous urethral rupture caused by straddle injury. Materials and Methods: From May 1995 to June 1996, early urethroscopic realignment was attempted on 16 consecutive patients with bulbous urethral rupture caused by straddle injury. These results were compared with those of 10 consecutive such patients who were managed initially with suprapubic cystostomy between July 1994 and April 1995. Results: Thirteen of the 16 patients(81%), including 1 with a complete rupture, had successful early urethroscopic realignment of the urethra and catheter placement. Ten of these 13 patients(77%), including 9 of 12 partial ruptures and 1 of 1 complete rupture, did not develop stricture after catheter removal. Of the 6 patients with partial rupture who were managed with initial suprapubic cystostomy, 2(33%) had no secondary stricture. All 4 patients with complete rupture managed with initial suprapubic cystostomy alone had resulting stricture. Conclusions: Early urethroscopic realignment of the ruptured urethra is a simple, safe, rapid, and nontraumatic technique that can be done with sedation and intraurethral topical anesthesia. It reduces the incidence of secondary urethral stricture compared with initial suprapubic cystostomy alone. Therefore, it could be a valuable alternative in the management of bulbous urethral rupture caused by straddle injury.