Primary endoscopic realignment

1. URETHRAL INJURY
&
PRIMARY ENDOSCOPIC REALIGNMENT
Dr. Eko Indra Pradono
Urology Division
Department of Surgery
Adam Malik General Hospital - Indonesia

2. AETIOLOGY OF URETHRAL INJURY

3. CLINICAL SIGNS
• Meatal Bleeding
• In ability to void
• Haematuria
• Pain on urination
• Urinary Extravasation & Bleeding in Scrotal, Penile, &Perineal
Swelling
• Ecchymosis
• DRE  ‘High Riding’ Prostate
• Inability to pass urethral catheter TRIAD Urethral
disruption :
blood at the meatus,
inability to urinate, and
palpably full bladder.

4. DIAGNOSTIC EVALUATION
• Retrogade urethrography
• Cystoscopy

5. Management of Anterior
Urethral Injuries in Men
Kitrey ND, Djakovic N, Gonsalver M, et al.
EAU Guidelines on Urological Trauma.
EAU. 2017

6. Management of posterior urethral injury:
• Primary surgical repair
• Puprapubic cystostomy with delayed
urethroplasty
• Primary endoscopic realignment of the
urethral end

7. POSTERIOR URETHRAL INJURY
The timing of the surgical intervention :
– Immediate : < 48 hours after injury;
– Delayed primary : two days to two weeks after injury;
– Deferred : > three months after injury.
Kitrey ND, Djakovic N, Gonsalver M, et al. EAU Guidelines on Urological

8. Management of posterior
urethral injuries in men
Kitrey ND, Djakovic N, Gonsalver M, et al. EAU
Guidelines on Urological Trauma. EAU. 2017

9. Primary Endoscopic Realignment
• Ormond and Cothran first described in 1934
• The aim is to correct severe distraction injuries rather than to
prevent a stricture
• Traditionally, urethral injury is managed with an initial
suprapubic cystostomy and urethral reconstruction 3 – 6
months after.
• Endoscopic re-alignment is the preferred technique.

10. Endoscopic Realignment
Benefits :
– a lower stricture rate
– if scarring and subsequent stricture formation occurs, the restoration
is simplified;
– for short strictures (< 2 cm), non-obliterative strictures  internal
urethrotomy
– for longer strictures, or in the case of failure of an internal
urethrotomy  urethroplasty
– if urethroplasty is required later, it is technically easier when the
prostate and urethra are well aligned
Kitrey ND, Djakovic N, Gonsalver M, et al. EAU Guidelines on Urological
Trauma. EAU. 2017

11. Endoscopic Realignment
Technique :
•Using a flexible/rigid cystoscope and biplanar fluoroscopy, a
guidewire is placed inside the bladder  a catheter is placed into
the bladder
•If necessary, two cystoscopes can be used : retrograde and
antegradely
•The duration of catheter stay varies between four and eight
weeks among series
Kitrey ND, Djakovic N, Gonsalver M, et al. EAU Guidelines on

12. Conclusion
•Primary Endoscopic realignment may have minimal effect of
complication because of lack of manipulation of surrounding
neurovascular bundles.

13. THANK YOU

14. Thank You