Reconstructive Surgery

We report the results of treatment of posterior urethral rupture (PUR) by primary realignment with some modifications of the technique. In this prospective study, 25 patients (mean age, 33.5 years; range, 18 to 70 years) in whom PUR had been proved underwent primary urethral realignment. All patients were evaluated postoperatively for urinary incontinence, erectile dysfunction, and urethral stricture. They were followed for a mean of 20 months (range, 9 to 27 months). In 20 of 25 patients (80%), posterior urethral rupture was associated with pelvic fractures and in 2 (8%), bladder rupture also was present. None of the patients had urinary incontinence. Six patients (24%) had evidence of postoperative stricture that required urethral dilatation and/or direct vision internal urethrotomy in 2 or 3 procedures under local anesthesia. Erectile dysfunction (which all responded to sildenafil) was reported by 4 patients (16%) as a decreased quality of erection. We believe that primary realignment of PUR is a simple procedure associated with low morbidity. It is recommended for patients who are stable and have no other significant intra-abdominal and pelvic organ injuries.