Endoscopic treatment of posttraumatic urethral obliteration: experience in 396 patients.

Of 396 patients with posttraumatic posterior urethral strictures treated endoscopically during 10 years 352 had no vesical displacement (group 1) and 44 had marked displacement (group 2). Group 1 patients were treated by suprapubic diversion and delayed optical urethrotomy. Exploration and railroad alignment to the urethra were done in group 2 and followup internal urethrotomy was performed in 33 patients. Eleven patients in group 2 and 68 in group 1 were considered failures due to complete short segment urethral obliteration. These 79 patients who failed initial visual urethrotomy underwent endoscopic resection of the stricture, that is core through optical urethrotomy. After 6 to 55 months (average 2 years) 46 patients (58.2%) were voiding satisfactorily (4 had stress incontinence). The 33 patients (41.8%) with failed minor or major endoscopic treatment due to persistent obstruction were treated with open urethroplasty. We conclude that posttraumatic posterior urethral obliteration can be treated by simple or major endoscopic techniques and that core through optical urethrotomy is a reasonable alternative to urethroplasty in patients with an impassable short stricture.