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 self‐calibration (CIC) was instituted in 10 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 ≤ 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 CIC 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 CIC significantly reduced stricture‐formation in our series.