Disrupting injuries of the membranous urethra--the case for early surgery and catheter splinting.

We reviewed the outcome following primary definitive repair by catheter splinting in 16 patients presenting with total posterior urethral disruption following pelvic injury. There were two deaths in the early post-operative period due to pulmonary embolism associated with other serious injuries. Five patients were judged to have a significant stricture at the site of injury, but all proved amenable to management with endoscopic treatment or periodic dilatation. None required a urethroplasty. The two cases with stress incontinence were related to concomitant injury of the bladder neck. Impotence persisted in 2 or 5 patients followed for longer than 12 months. Complications from catheter traction were not seen using the system of light interrupted traction described. A case is made for primary management by catheter splinting of such urethral injuries.