Traumatic Injuries to the Urethra

Abstract

Major urethral injuries from external trauma are complex problems of diagnosis and treatment. Complications resulting from injury, failed diagnosis and inappropriate therapy incude stricture, impotence and incontinence. Opinions differ as to whether immediate suprapubic cystostomy followed by later reconstruction is preferable to immediate direct urethral realignment. A review of 30 patients with urethral injuries is presented, 27 male and 3 female, 29 from blunt trauma and 1 gunshot. Initial suprapubic cystostomy alone was used in 26 male patients, 21 with prostatomembranous disruption and 5 with straddle injury. Prostatomembranous reconstruction in 14 complete urethral transections resulted in 1 residual stricture, 2 impotent patients and no incontinence. Partial prostatomembranous disruption and straddle injuries had insignificant residual stricture, none requiring dilation or reconstruction. The results of this management approach appear superior to those of immediate urethral realignment. Advantages of immediate suprapubic cystostomy are simplified early approach in management, and successful elective reconstruction of major prostatomembranous injuries with low incidence of stricture, impotence and incontinence.