Early endoscopic primary realignment decreases stricture formation and reduces medical costs in traumatic complete posterior urethral disruption in a 2-year follow-up.

BACKGROUND There are presently several options for the management of posterior urethral disruption. However, these options remain controversial for several reasons. Thus, this medical issue has been continuously investigated. METHODS From 1991 to 2001, 22 patients with complete posterior urethral disruption out of 720 urethral injury cases were retrospectively reviewed using strict criteria. The 22 cases were grouped into two different management groups, the endoscopic early realignment (ER) group and the delayed urethrotomy (DU) group. The frequency of optic internal urethrotomy for urethral strictures and individual medical costs were evaluated over a two-year period. RESULTS The ER group had a mean frequency of 1.3 ± 0.82 urethrotomies in the first year and 1.8 ± 1.23 over two years while the DU group had a significantly higher urethrotomy frequency, 2.5 ± 1.35 in the first year and 4.1 ± 1.91 over two years. The costs for the DU group were 50% higher than the ER group at the end of second year. CONCLUSION An early endoscopic realignment operation saved up to NT 36,000 (New Taiwan Dollars) in costs with an average of 2.3 fewer further urethrotomy procedures in each case during the 2-year follow-up period. Therefore, early urethral realignment for traumatic complete posterior urethral disruption should be encouraged to prevent intractable urethral stricture and lower medical costs.