The importance of accurate assessment and conservative management of the open bladder neck in patients with post-pelvic fracture membranous urethral distraction defects.

OBJECTIVE

To review the pre-operative assessment of bladder neck competence and assess the success of non-operative management of the bladder neck in patients with pelvic fracture membranous urethral distraction defects.

PATIENTS AND METHODS

A series of four patients with long-standing post-pelvic fracture urethral distraction defects and open bladder necks demonstrated on pre-operative investigation are presented.

RESULTS

All four patients were managed by perineal urethroplasty without surgery to the bladder neck. All patients were continent post-operatively despite the injury having ablated the distal sphincter mechanism.

CONCLUSION

We believe that the majority of patients can be managed successfully by a non-operative approach to the bladder neck, sparing them the unnecessary operative morbidity of an abdomino-perineal repair, which should be reserved for those with obviously scarred or distorted bladder necks.