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EARLY REALIGNMENT FOR THE TREATMENT OF DISRUPTED POSTERIOR URETHRAL INJURY VERSUS DELAYED MANAGEMENT: A COMPARITIVE STUDY.

Imran Memon, Syed Farhan Ahmed, Syed Azhar Hussain Shah, Shahzaib Habib.

Purpose: Urological treatment of the patient with severe mechanical trauma and urethral disruption remains controversial. Debate continues regarding the advisability of early realignment vs delayed open urethroplasty. We have compared our experience of 46 patients to determine the long-term results of the 2 approaches. Materials and Methods: Multicenter comparitive study was conducted in two centers, Liaquat National Hospital Karachi and Asian Institute of Medical Sciences Hyderabad. Total 46 men with posterior urethral disruption after severe blunt pelvic injury between JAN 2014 and DEC 2018, 23 patients who underwent early realignment were compared to those on 23 treated with delayed urethroplasty with an average 2-year followup. All patients were evaluated postoperatively for incontinence, impotence and urethral strictures. Results: Diagnosis of urethral rupture was based on clinical findings and retrograde urethrography. Strictures developed in 49% of the early realignment group and in 100% of the suprapubic tube group. Impotence (33.6%) and incontinence (17.7%) were less frequent in the early realignment group than in the delayed reconstruction group (42.1% and 24.9%).Patients with delayed reconstruction underwent an average of 3.1 procedures compared with an average of 1.6 in the early realignment group. Conclusions: Early realignment may provide better outcomes than delayed open urethroplasty after posterior urethral disruption. Increased complications are not seen and, although it can be inconvenient in the massively injured patient, it appears to be a worthwhile maneuver. Key Words: urethra, wounds and injuries, urethral stricture, pelvis, fracture

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