Evaluation of immediate endoscopic realignment as a treatment modality for traumatic urethral injuries

Background: Traumatic urethral injuries have been traditionally managed by suprapubic drainage with a delayed repair. Advances in endoscopic techniques have facilitated early realignment and transurethral catheterization of the injured segment as a new management option. The purpose of this study was to investigate the outcomes of patients undergoing immediate endoscopic realignment (IER) compared with delayed treatment (DT). Methods: Trauma patients sustaining a traumatic urethral injury admitted to a level I trauma center were prospectively identified and followed through their course of treatment. Injury demographics and outcomes were compared for IER versus DT. The primary outcome measures were time to spontaneous voiding and urethral stricture rate. Results: Of 21 patients with acute urethral injuries, 14 (67%) had IER and 7 (33%) had DT (4 IER failures and 3 primary DT). The 4 IER failures represent 22% of the patients in the immediate realignment attempt group that failed and went on to delayed therapy. Mean follow-up was 7 months (range, 14 days to 1.7 years). IER and DT groups were similar with regards to age (30 +/- 16 vs. 24 +/- 6), mechanism of injury (blunt vs. penetrating), location of urethral injury (anterior vs. posterior), Glasgow Coma Scale score (13 +/- 3 vs. 12 +/- 6), ISS (14 +/- 11 vs. 20 +/- 6), and associated injuries (pelvic fractures and intra-abdominal injuries). Mean time to IER from admission was 32 80 hours (range, 1 hour-2.8 days). Patients undergoing IER had a significantly shorter time to spontaneous voiding (35 +/- 23 vs. 229 +/- 79 days, p = 0.001) and had a significantly decreased rate of stricture formation (14% vs. 100 %, p < 0.0001). All DT patients required formal surgical urethroplasty whereas the 2 (14%) IER patients with strictures only required outpatient clinic dilatation. Conclusion: Compared with the traditional DT approach, IER results in a significantly reduced time to spontaneous voiding with less risk of urethral stricture, possibly avoiding the need for surgical urethroplasty and long-term suprapubic urinary diversion.