Complete Urethral Disruption: The West Virginia Experience

Julio Davalos, Brian Defade*, J. p. Tierney*, Stanley J Kandzari, Stanley Zaslau
West Virginia University, Morgantown, WV

Introduction: Complete urethral disruption is an uncommon injury. Treatment options vary, and recommendations continue to evolve. We review the management and outcomes of this medical entity.
Methods: A retrospective review was performed. Charleston Area Medical Center had 17 patients with urethral disruption of approximately 9,000 trauma patients. West Virginia University Hospitals had 13 patients with urethral disruption of approximately 17,000 trauma patients. Of these combined 30 patients, 10 patients had a complete urethral disruption
Results: Eleven patients (37%) had a Type I injury, 9 (30%) a Type II, and 10 (33%) had a Type III urethral injury. Of the patients with a Type III injury, initial management was a Foley catheter only (20%), a suprapubic catheter only (60%), or both catheters (20%). Endoscopic realignment was performed in 4 (40%) patients, open urethroplasty in 4 (40%) patients, and conservative, non-surgical management in the remaining 2 (20%) patients. Full return of urinary function was noted in 100% of patients managed conservatively, 75% of patients managed endoscopically, and in 25% of patients with an open repair. Erectile function was preserved in 100% of patients conservatively managed, 50% of patients with an endoscopic repair, and in none of the patients with an open repair
Conclusions: Type III urethral disruption is an uncommon injury that occurs in male patients with pelvic trauma. Urinary and erectile function is better preserved with a non-surgical or endoscopic repair versus open repair. When conservative management is not possible, endoscopic repair is the treatment of choice.

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