Clinical evaluation of cases of lower genitourinary tract trauma with special reference to primary realignment in cases of posterior urethral distraction defect

Vikash Kumar, Krishna Kant Singh, Dhirendra Pratap, H. S. Pahwa, Mehboob Alam


Background: The exact management strategy for lower genitourinary tract trauma remains controversial. Primary realignment with/without suprapubic catheterization provides definitive procedure with low complications and avoids the need for further open surgeries.

Methods: This was a prospective longitudinal study done on 31 cases with different complaints related to lower tract genitourinary trauma. All patients underwent suprapubic catheterization and/or primary realignment. The outcome was measured in the terms of time for discharge, urinary incontinence, stricture formation, erectile dysfunction and impotence.

Results: Maximum proportion of patients with lower genitourinary injuries in the study was in 10-20 years age group (48.4%). Blunt trauma was accounted for 93.6% of lower genitourinary injuries. Road traffic accidents were the most common cause (90.32%) of lower genitourinary injuries. Urinary bladder injuries accounted for 41.9% of all lower genitourinary injuries. Blood at meatus is present in only about half of the significant urethral injuries. Primary realignment of urethral injury results in lesser duration of hospital stay (9.24±2.44 days), shorter length of suprapubic catheterization (11.67±4.78 days) and early spontaneous voiding (40.93±15.79 days). The stricture rate following primary realignment is low (31.25%). Erectile dysfunction was noted only in two patients (16.6%).

Conclusions: Management of traumatic urethral disruption by primary realignment serves as ultimate therapy in majority of patients.


Lower genitourinary tract trauma, Posterior urethral distraction, Primary realignment

Full Text:



Koraitim MM, Marzouk ME, Atta MA, Orabi SS. Risk factors and mechanism of urethral injury in pelvic fractures. Br J Urol. 1996;77(6):876-80.

Guillé F, Cippola B, El Khader K, Lobel B. Early endoscopic realignment for complete traumatic rupture of the posterior urethra-21 patients. Acta Urol Belg. 1998;66:55-8.

Chapple C, Barbagli G, Jordan G, Mundy AR, Rodrigues-Netto N, Pansadoro V, et al. Consensus statement on urethral trauma. BJU Int. 2004;93(9):1195-202.

Mouraviev VB, Coburn M, Santucci RA. The treatment of posterior urethral disruption associated with pelvic fractures: Comparative experience of early realignment versus delayed urethroplasty. J Urol. 2005;173(3):873-6.

Asci R, Sarikaya S, Buyukalpelli R, Saylik A, Yilmaz AF, Yildiz S. Voiding and sexual dysfimctions after pelvic fracture urethral injuries treated with either initial cystostomy and delayed urethroplasty or immediate primary urethral realignment. Scand J Ural Nephroi. 1999;33(4):228-33.

Kotkin L, Koch MO. Impotence and incontinence after immediate realignment of posterior urethral trauma: result of injury or management? J Urol. 1996;155(5):1600-3.

Leddy L, Voelzke B, Wessells H. Primary realignment of pelvic fracture urethral injuries. Urol Clin North Am. 2013;40(3):393.

Koraitim MM. Pelvic fracture urethral injuries: The unresolved controversy. J Urol. 1999;161(5):1433-41.

Kamal B. Primary urethral realignment in traumatic urethral rupture. Bahrain Med Bull. 2000;22:64-7.

Johanson B. Reconstruction of the male urethra stricture: Application of the buried intact epithelium technique. Acta Chir Scand Suppl. 1953;176:1-4.

Lieberman SF, Barry JM. Retreat from transpubic urethroplasty for obliterated membranous urethral strictures. J Urol. 1982;128:379-81.

Morehouse DD, Mackinnon KJ. Management of prostatomembranous urethral disruption: 13-year experience. J Urol. 1980;123:173-4.

Herschorn S, Thijssen A, Radomski SB. The value of immediate or early catheterization of the traumatized posterior urethra. J Urol. 1992;148(5):1428-31.

Johnsen NV, Dmochowski RR, Mock S, Reynolds WS, Milam DF, Kaufman MR. Primary Endoscopic Realignment of Urethral Disruption Injuries-A Double-Edged Sword? J Urol. 2015;194(4):1022-6.

Dobrowolski ZF, Weglarz W, Jakubik P, Lipczynski W, Dobrowolska B. Treatment of posterior and anterior urethral trauma. BJU Int. 2002;89:752-4.

Elliott DS, Barrett DM. Long-term fellow up and evaluation of primary realignment of posterior urethral disruptions. J Urol. 1997;157:814-6.

Hadjizacharia P, Inaba K, Teixeira PG, Kokorowski P, Demetriades D, Best C. Evaluation of immediate endoscopic realignment as a treatment modality for traumatic urethral injuries. J Trauma. 2008;64(6):1443-50.

Corriere JN, Rudy DC, Benson GS. Voiding and erectile function after delayed one-stage repair of posterior urethral disruptions in 50 men with a fractured pelvis. J Trauma.1994;37(4):587-90.

Routt MC, Simonian PT, Defalco AJ, Miller J, Clarke T. Internal fixation in pelvic fractures and primary repairs of associated genitourinary disruptions: a team approach. J Trauma. 1996;40(5):784-90.