| Summary: | Objectives: The aim of our study is to assess the value of deferred endoscopic urethral realignment after traumatic posterior urethral disruption.
Patients and methods: Between June 2001 and August 2011, we evaluated 28 patients who presented 3–6 weeks (mean 27 ± 6 days) after experiencing traumatic posterior urethral disruptions and pelvic fractures; immediate and early realignment were overdue in these cases. Patient variables included mode of presentation, mechanism of trauma, type of pelvic fracture, and Abbreviated Injury Scale (AIS). Under fluoroscopic guidance, a guidewire was passed into the injured urethral segment from the distal to proximal injured ends using a long Chiba needle, and realignment was performed using endoscopic urethrotomy. The follow-up period ranged from 18 to 98 months (mean 43 ± 22.5 months).
Results: After the procedure, 46% of patients were stricture free. After one visual internal urethrotomy (VIU) and two VIU's, 60% and 64% of patients were stricture free. No cases of post-procedural incontinence occurred, and impotence was reported in only 14% of patients. Type of pelvic fracture was the only variable that significantly affected the success rate, where the success rate decreased from 100% in stable pelvic fracture to 25% in bilateral rotationally and vertically unstable pelvic fracture.
Conclusion: When early realignment is postponed for any reason, deferred endoscopic realignment is considered an adequate substitute because urethral continuity can be achieved in a group of patients without increase incidence of impotence and incontinence.
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