Controversies in management of urethral trauma after pelvic fracture in men.

Abstract

Whenever trauma of the urethra is suspected a "test" catheterisation is potentially bad and useless. Retrograde urethrography should be performed before use of any catheter. Doctors in urgency department should be trained to do this. Suprapubic diversion under imaging guidance is the best solution when trauma is diagnosed. In complete rupture without extreme displacement of both ends of the urethra, reconstruction is foreseen at day 7 to 10 after trauma. Bleeding is stopped at that moment and elasticity of the tissues is still sufficient. A second urethrogram the day before intervention is advocated for better judgement of the lesions. Endoscopy with a flexible endoscope from above is performed as the first step of the operation. Minor distances or incomplete lesions of the urethra can be coped with endoscopic realignment. Distances of more than 1 cm are treated by open perineal route only leaving the pelvic hematoma closed. This technique should be restricted to referee centers in view of the small numbers of cases.