Urethral injuries

Summary

We report 68 patients (62 men, 6 women) with urethral injuries, 93% resulting from blunt trauma and 7% from penetrating, trauma. Blood at the urethral meatus was the most reliable indicator of prostatomembranous disruption (49 of 50; 98%), and pelvic fracture was also present in 98% of these patients. Initial cystostomy was the preferred management with delayed urethral reconstruction when necessary. For repair of the prostatomembraous stricture, a combined perineal/ lower abdominal approach with pubectomy (in 30 of 33) provided exposure for complete scar excision and primary urethro-urethral anastomosis. In bulbar (straddle) injuries, the strictures did not require repair. Pendulous injuries were all from gunshots (penetrating) and were immediately repaired. In 37 of the men with complete or partial prostatomembranous disruption, 6 (16%) became impotent. Two visual urethrotomies and two repeat urethroplasties were successful for recurrent strictures. None of the patients require urethral dilation and mean urinary flow rates for the men are 18.5 ml/s. Urinary continence was achieved in all patients. This approach to management of urethral rupture provides excellent results for these severely injured patients.