Results of delayed repair of posterior urethral disruption injuries in Maiduguri

Aim Posterior urethral disruption injuries (PUDI) are common and on the increase because of vehicular accidents and civil conflicts. The operative management of PUDI continues to pose a challenge to the urologist because of erectile dysfunction and incontinence from the injury or following repair. The aim of the present study was to review the outcome of delayed repair of PUDI. Patients and Methods The present study is a retrospective study of all male patients who underwent operation for PUDI at a urology unit between April 2008 and September 2010. The causes, presentation, diagnostic investigations, initial management, definitive operative management and complications were obtained from patients' clinical records. Results Forty-five male patients with PUDI were managed; their mean age was 37.38 ± 20.014 years (range 8–80 years). Most of the injuries were because of vehicular accidents (46.67 per cent) and missile injuries (15.56 per cent). The presenting features included inability to pass urine (100 per cent), bleeding from the urethra (60 per cent) and suprapubic swelling and pain (86.67 per cent). The initial management was a suprapubic cystostomy. Twenty-nine (64.44 per cent) patients had associated pelvic fracture, 17 (37.78 per cent) long bone fractures and 13 (28.89 per cent) bladder injuries. Other associated injuries included the bowel, head, ribs and liver (31.12 per cent). The perineal approach in repair was effected in 37 (82.22 per cent) patients, and eight (17.78 per cent) had combined abdominal and perineal approaches. The urine flow rate was 15–20 mL/s in 36 (80 per cent) patients, and 10–15 mL/s in nine (20 per cent) patients. The main postoperative complications included wound infection, incontinence and erectile dysfunction. Conclusion PUDI are on the increase in north-eastern Nigeria because of increases in road vehicular accidents and firearm injuries from civil strife. The main causes of PUDI in Maiduguri are road vehicular accidents, firearms and civil strife. The results of delayed repair are equally good, despite the absence of immediate endoscopic realignment.