Introduction: Pelvic Fracture Urethral Injury (PFUI) is a rare but challenging to treat. The initial optimal management is not defined.
The objective of the present study was to access short and long term results of early endoscopic realignment (EER) performed for male urethral disruption in a French university hospital.
Methods: All men who underwent an early endoscopic realignment for a PFUI between decembre 2004 and may 2019 in our center were included. Preoperative and perioperative outcome data were collected. The rate of complications for the surgical procedure was analyzed, as well as the rate of post-operative stenosis, erectile dysfunction and incontinence.
The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow up.
Results: Twenty-four patients were included: 17 posterior urethral disruption and 7 anterior. The median time to realignment was 9 days (4-19). There were 3 realignment failure. The median operative time was 30 minutes (10-150). 18 of 21 patients resumed micturition after the surgery, one patient had an early post-operative urethral stricture, and two patients had perineal abscesses and were referred to an outside center for urethroplasty. Initial success rate of the procedure was 29.2% (7/24). Mean follow up time was 36 months (4-190).Eleven of 18 patients developed a urethral stricture during follow up. Seven patients were treated by one or two direct visual internal urethrotomy. Finally, only 8/24 patients (33,33%) required urethroplasty. There were no urethroplasty failure after previous EER. One patient reported stress urinary incontinence after two urethroplasty. There were insufficient data to conclude about erectile dysfunction.
Conclusions: Early endoscopic realignment for PFUI has a low initial success rate but a majority of patients can benefit from endoscopic treatment afterwards and it did not compromise later urethroplasty. Thus, it seems licit to propose EER as first treatment for PFUI.
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