[Comparative results of the treatment of post-traumatic ruptures of the membranous urethra with endoscopic realignment and surgery].

Objective: Retrospective, comparative study of the long-term results of endoscopic realignment and surgery in the treatment of complete rupture of the posterior urethra.

Material And Methods: Between 1989 and 1998, 40 men were managed for traumatic posterior rupture of the membranous urethra: 30 were treated by endoscopic realignment for complete rupture while 10 were treated by surgery (perineal or transsymphyseal incision) for a long stenosis (> 3 cm) secondary to extensive rupture of the urethra.

Results: With a mean follow-up of 30 months (12 to 72 months), all patients treated by endoscopic realignment are continent and urinate with a satisfactory urine output (Qmax > or = 15 ml/s). This result was obtained after internal urethrotomy in 7 patients (23.33%) and transperineal urethroplasty in one patient. Six patients developed persistent impotence (20%). For the ten patients treated surgically, the voiding stream was considered to be satisfactory (Qmax > 15 ml/s in 6 patients while 4 developed short strictures accessible to endoscopic urethrotomy. Nine patients are continent, while one completely incontinent patient with perineal fistulas required a continent cystostomy. Four out of 10 patients reported sexual impotence.

Conclusion: Endoscopic realignment of complete rupture of the membranous urethra is a simple, minimally aggressive technique, ensuring optimal preservation of continence and sexuality in young subjects.