Visual urethrotomy in the management of the obliterated membranous urethra

Delayed direct-vision internal urethrotomy is a reasonable first treatment of the traumatically obliterated posterior urethra. Postoperative continence is achieved if the bladder neck is competent on preoperative cystogram. Simultaneous suprapubic and transurethral instrumentation most accurately define the length of obliterated urethra, and rectal examination determines any prostatic displacement. Half the patients will require repeat endoscopic surgery for significant stricture, and all require long-term follow-up to assure urethral patency. Potency is not affected by the procedure. Urethrotomy failure should not preclude a subsequent open procedure.