Primary Endoscopic Realignment Following Posterior Urethral Disruption

We describe 5 cases in which complete posterior urethral disruption associated with pelvic fracture was managed by primary endoscopic realignment 7 to 19 days after injury. Realignment was accomplished using a flexible endoscope through the suprapubic tract and a rigid or flexible cystoscope in the distal urethra. A guide wire was passed from the suprapubic tract through the disrupted membranous urethra and out the distal urethra. A Councill catheter was left indwelling for 5 to 10 weeks. After removal a program of intermittent self-catheterization was continued for 3 months. Excellent results were obtained in 4 patients who are continent, including 2 who are potent. This technique allows considerable reduction of patient morbidity without compromising formal urethroplasty should it later be required.