title: A new technique for immediate endoscopic realignment of post-traumatic bulbar urethral rupture.
abstract: OBJECTIVE
  Urethral injury with partial or complete disruption of urethral integrity can lead to voiding problems and serious infections. We report a new management technique involving immediate endoscopic realignment with drainage via peel-away sheath for post-traumatic bulbar urethral rupture.
  
  
  METHODS
  Thirteen patients presenting with post-traumatic bulbar urethral rupture between July 2010 and May 2013 were treated. An 18F peel-away sheath was inserted into the anterior urethra, then a ureteroscope or nephroscope was inserted into the peel-away sheath with continuous normal saline infusion and drainage through the cavity between ureteroscope and sheath to maintain operative field clarity. A guide wire was negotiated across the disruption to the bladder and an 18F Foley catheter inserted for 2-4 weeks. Rupture severity was evaluated by urethroscopy during operation. Two patients had partial urethral rupture and 11 complete rupture. Before Foley catheter removal, pericatheter urethrography was performed to determine if urinary extravasation had occurred. Urethroscopy was performed after catheter removal. Follow-up uroflowmetry was conducted monthly for 1 year.
  
  
  RESULTS
  This technique was successful in all patients and none experienced urinary extravasation or required open surgery. Mean operation time was 4.9±1.6 min (3-8 min) and the mean Foley catheter indwelling time was 25.8±5.3 days. During follow-up (18.4±5.4 months, 12-26 months), 6 patients developed urethral strictures (8.7±10.5 weeks, 1-28 weeks post-treatment). Strictures were managed by internal urethrotomy (1 patient) or urethral sound dilation (5) without open urethroplasty.
  
  
  CONCLUSIONS
  Immediate endoscopic realignment with drainage via peel-away sheath is a fast, effective, and safe technique for bulbar urethral rupture.
authors.affiliation: Department of Urology, 175th Hospital of PLA, Xiamen University Affiliated Southeast Hospital Zhangzhou 363000, Fujian, China.
authors.forename: Congxiang
authors.initials: C
authors.lastname: Han
authors.affiliation: Department of Urology, 175th Hospital of PLA, Xiamen University Affiliated Southeast Hospital Zhangzhou 363000, Fujian, China.
authors.forename: Jinyu
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Urology, 175th Hospital of PLA, Xiamen University Affiliated Southeast Hospital Zhangzhou 363000, Fujian, China.
authors.forename: Xiacong
authors.initials: X
authors.lastname: Lin
authors.affiliation: Department of Urology, 175th Hospital of PLA, Xiamen University Affiliated Southeast Hospital Zhangzhou 363000, Fujian, China.
authors.forename: Zhongying
authors.initials: Z
authors.lastname: Yu
authors.affiliation: Department of Urology, 175th Hospital of PLA, Xiamen University Affiliated Southeast Hospital Zhangzhou 363000, Fujian, China.
authors.forename: Xianzhong
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of Urology, 175th Hospital of PLA, Xiamen University Affiliated Southeast Hospital Zhangzhou 363000, Fujian, China.
authors.forename: Weijie
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Urology, 175th Hospital of PLA, Xiamen University Affiliated Southeast Hospital Zhangzhou 363000, Fujian, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
keywords: Endoscopic realignment; bulbar urethra; post-traumatic; urethral rupture