11 SUCCESS RATE OF EARLY PRIMARY URETHRAL REALIGNMENT IS INDEPENDENT OF THE SEVERITY OF PELVIC TRAUMA AFTER TOTAL POSTERIOR URETHRAL DISRUPTION

INTRODUCTION AND OBJECTIVES: Recent studies have shown a role for early urethral primary realignment after complex pelvic trauma. Technical difficulties may be overcome with appropriate technique and technology. We examined the success rate of early urethral primary realignment of total posterior urethral disruption after complex pelvic trauma and the correlation of the severity of pelvic fracture. METHODS: An analysis of a prospective database was performed of patients with pelvic fracture associated with total urethral disruption underwent urethral realignment from 2005 to 2012 at Level I Trauma Center. Fractures were classified according to the orthopedic Young-Burgess classification. Initial urological management consisted of suprapubic tube insertion when the patient was unable to void. We utilized anterograde flexible cystoscopy via suprapubic tube, retrograde rigid cystoscopy and real-time fluoroscopy. Failure of realignment was defined as the inability of urethral catheterization using a retrograde/ anterograde approach. Follow up consisted of urethrograms, urofluxometry and cystoscopy evaluation. We also analyzed continence and erectile function after trauma. The necessity of other procedures such as dilatation, DVIU or urethroplasty was also evaluated after catheter removal. RESULTS: A total of 480 consecutive patients were screened and we found 18 patients with total posterior urethral disruption after complex pelvic trauma with the inability to void. The mean patient age was 40 years. The success rate of the procedure was 100%. Mean operating time was 47 11 minutes. Estimated blood loss was minimal. A total of patients 50.0% had associated organ related injuries. The realignment was accomplished within 3 days after admission. There was no correlation between the orthopedic type of classification and the success of urethral realignment. A total of 10 (56%) patients developed urethral strictures during follow up. Urinary incontinence occurred in 3 (17%) patients and 10 (56%) patients self-reported erectile dysfunction after the trauma. The mean follow up of these patients were 30.2 months. CONCLUSIONS: Early primary endoscopic realignment of total posterior urethral disruption after complex pelvic trauma had 100% success rate due to technology and surgical technique. Moreover, there was no correlation of the severity of pelvic fracture. Pelvic orthopedic classification did not show correlation with post procedure urinary incontinence or erectile function after the trauma.