The importance of accurate assessment and conservative management of the open bladder neck in patients with post-pelvic fracture membranous urethral distraction defects.
OBJECTIVE
To review the pre-operative assessment of bladder neck competence and assess the success of non-operative management of the bladder neck in patients with pelvic fracture membranous urethral distraction defects.


METHODS
A series of four patients with long-standing post-pelvic fracture urethral distraction defects and open bladder necks demonstrated on pre-operative investigation are presented.


RESULTS
All four patients were managed by perineal urethroplasty without surgery to the bladder neck. All patients were continent post-operatively despite the injury having ablated the distal sphincter mechanism.


CONCLUSIONS
We believe that the majority of patients can be managed successfully by a non-operative approach to the bladder neck, sparing them the unnecessary operative morbidity of an abdomino-perineal repair, which should be reserved for those with obviously scarred or distorted bladder necks.
Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.
S
S
MacDiarmid
D
D
Rosario
C R
CR
Chapple
D000293:Adolescent; D000328:Adult; D050723:Fractures, Bone / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D011182:Postoperative Care; D011300:Preoperative Care; D016896:Treatment Outcome; D014521:Urethra / Q000293:injuries*; D001743:Urinary Bladder / Q000293:injuries*; D014555:Urination Disorders / Q000209:etiology / Q000601:surgery