Primary endourologic realignment of complete posterior urethral disruption.

The management of posterior urethral disruption is controversial. Debate continues on whether primary realignment at results in a higher incidence of incontinence and impotence compared to delayed reconstruction. We report on our experience using early endoscopic realignment. Between 1994 and 2002 ten male patients, diagnosed with complete posterior urethral disruption, had attempted early endoscopic realignment. All patients were evaluated for incontinence, impotence and stricture formation post-operatively. Six patients had endoscopic retrograde realignment, two proceeded to endoscopic rendezvous realignment and two patients had delayed reconstruction of the urethra. At follow-up, mean 41.4 months, all patients were continent four were impotent and four patients developed strictures. Endoscopic retrograde realignment is a simple atraumatic technique for early posterior urethra realignment. If unsuccessful a rendezvous approach can be attempted at the same operation. Manipulation of the periprostatic issue is minimal thus preventing iatrogenic complications.