Rigid retrograde endoscopy under regional aneasthesia: a novel technique for the early realignment of traumatic posterior urethral disruption

Abstract

Traumatic disruption of the posterior urethra usually occurs in association with pelvic fractures and may result in significant morbidity. The management of this injury remains difficult and controversial. Recently, early restoration of urethral continuity in these patients using cither both antegrade and retrograde cystoscopy (with or without fluoroscopy), or flexible retrograde urethroscopy alone under general aneasthesia, has been reported with good results. These procedures have been proposed as an improvement over the traditional teaching of placement of a suprapubic catheter followed by delayed open repair (urethroplasty). We now describe a novel method of restoration of urethral continuity by rigid retrograde endoscopy alone under caudal aneasthesia in the early post-trauma phase. This procedure can be carried out in an outpatient endoscopic suite with standard (endoscopic) optical urethrotomy equipment and is suitable for most patients with prostatomembranous urethral disruptions. A 'high-riding' prostate is however a relative contraindication for this procedure. To date, we have carried out this procedure successfully in 4 of 5 patients with traumatic prostato-membranous disruption (a success rate of 80%). We recommend that early retrograde rigid endoscopic realignment under regional analgesia should be considered as a management option in patients with traumatic disruption of the posterior urethra.