Long-term followup and evaluation of primary realignment of posterior urethral disruptions

Purpose: We analyzed the long-term results of treatment of posterior urethral disruptions with immediate primary realignment. Materials and Methods: A total of 57 patients with posterior urethral disruptions (56 complete and 1 partial) underwent primary urethral realignment within 6 hours after injury. Pelvic fractures were present in 52 patients. In all cases the actual operating time for realignment was 1.25 hours or less. All patients were evaluated postoperatively for incontinence, impotence and strictures. Mean followup was 10.5 years (range up to 40 years) after injury and 53 patients were available for long-term followup. Results: Erections - 42 of 53 patients (79%) reported no erectile dysfunction, 7 (13%) reported decreased quality of erection but required no treatment and 4 (7.5%) had erectile dysfunction requiring treatment. Incontinence - 2 of 53 patients (3.7%) reported mild post-realignment stress incontinence. Both patients did not need treatment for incontinence or protective padding. Strictures - 18 of 53 patients (34%) had evidence of post-realignment strictures and required no further urethral dilation or surgical intervention. Mean followup for these 18 patients was 12 years 2 months. A total of 36 patients (68%) had post-realignment strictures; however, 23 (43.4%) were considered to have mild strictures that were observed or easily managed with in-office dilation. Mean followup for these patients was 8.5 years. Of the 53 patients 13 (24.5%) had more significant strictures that required a repeat procedure using general anesthesia. A total of 20 procedures was required to treat the 13 patients. Of the 20 procedures done using general anesthesia 16 (80%) were completed on an outpatient basis. The remaining 4 patients required urethroplasty. Mean followup of the 13 patients was 11 years 9 months. Conclusions: Immediate primary realignment resulted in negligible intraoperative morbidity, and acceptably low incidences of impotence, incontinence and symptomatic strictures.