Management of Prostatomembranous Urethral Disruption: 13-Year Experience

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Abstract
Initial management of all cases of prostatomembranous urethral disruption since 1965 has consisted of suprapubic cystostomy alone. A significant number of cases treated elsewhere with this technique were referred to this institution for definitive treatment of the obliterated urethra. The results were reviewed with reference to the surgical technique, need for additional surgery, urethral patency, urinary control and sexual potency. Of 61 cases managed with this method 58 ruptures were complete and 3 were incomplete. The incomplete cases required no treatment other than the initial cystostomy. Urinary continence without stricture was achieved in 60 cases. Reoperation was required for stricture in 2 cases. The low incidence of sexual impotence (10% or less, depending on the eventual pattern in the children included in the series) had led some observers to suggest that preselection or faulty injury classification might explain such favorable results. However, the cases represented the usual spectrum and the diagnostic approach was standard and acceptable. Complications associated with this injury frequently are iatrogenic. To assist in prospective evaluation, a protocol has been established. More accurate recording of all events associated with the injury eventually will permit a conclusion in this rather long-standing therapeutic controversy.