Comparison of long-term results according to the primary mode of management of injury for posterior urethral injuries

The management of post-traumatic rupture of the posterior urethra remains controversial, leaving the choice between early endoscopic realignment (EER) or suprapubic catheterization with deferred urethroplasty. The objective is to compare the results of endoscopic realignment and those of urethroplasty in terms of voiding.

We underwent a retrospective study collating all patients managed for post-traumatic complete urethral rupture between 2010 and 2020. These patients were subdivided into two groups: a first one including those who had an endoscopic realignment and a second one including those who had a deferred urethroplasty. We studied the quality of voiding and the complications that occurred in each group. The success of the technique was defined by the resumption of a satisfactory voiding, and the absence of recourse to the urethroplasty in case of endoscopic realignment. Satisfactory voiding was defined by a Qmax ≥ 15 mL/s and a post-void residual (PVR) < 150 ml by ultrasound.

Fifty-eight patients were identified. The mean age was 32 ± 12 years. Endoscopic realignment was performed in 26 patients. Satisfactory voiding was reported in 16 patients (61.53%). Recourse to internal urethrotomy after realignment was reported in 7 patients (26.92%). Three failures of endoscopic realignment were reported, necessitating an urethroplasty. Two patients reported urinary incontinence. Urethroplasty was performed in 32 patients. Satisfactory voiding was noted in 22 patients (68.75%). The use of internal urethrotomy after surgery was reported in 5 patients (15.62%). Three patients had treated urinary incontinence. Comparing the two groups, there was no significant difference in postoperative IPSS, flow rate (Q_max), post-void residual urine volume (PVR), satisfactory voiding, and stress urinary incontinence.

The voiding outcomes were comparable for both techniques. We conclude that endoscopic realignment can be indicated in first intention, provided certain conditions are met, in order to minimize the morbidity of prolonged suprapubic drainage.