Primary realignment of prostatomembranous urethral disruptions

Management of prostatomembranous urethral disruptions remains controversial. Advocates of delayed urethral reconstruction suggest that immediate repair provides inferior outcomes in terms of impotence and incontinence. However, review of the literature, provides strong evidence that the injury itself is the most important factor in determining outcome because impotence appears to be the result of injury to the corpora cavernosa. Moreover, techniques for immediate urethral realignment provide outcomes that are equivalent to delayed-repair approaches while eliminating the need for long-term suprapubic catheter drainage and multiple surgical procedures for reconstruction. Techniques for immediate urethral realignment, along with outcomes at the Vanderbilt University Medical Center (Nashville, TN) are presented. Potency and continence rates of 83% and 100% were achieved, with early realignment of complete prostatomembranous urethral disruptions. These results are comparable to or exceed those of delayed-repair approaches.