| Immediate | - Performed within 24 to 72 hours post-injury.
- May be attempted in hemodynamically stable patients.
- Should be accomplished with minimal manipulation; avoid prolonged attempts or excessive irrigation.
- May be associated with restricturing, incontinence, erectile dysfunction, or injury to the rectum.
| - Performed within 24 to 72 hours post-injury.
- May reduce stricture length or severity in some patients.
- May be associated with stricture recurrence.
- Generally not recommended due to the risk of significant bleeding from a retropubic hematoma with the open approach.
| | - Only appropriate when there is concomitant bladder neck or rectal injury, or another indication for open laparotomy.
- Otherwise not recommended due to high rates of blood loss, impotence, incontinence, and stricture recurrence.
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| Delayed | - Performed 5 to 7 days post-injury, typically in conjunction with another procedure (eg, orthopedics).
- May reduce the stricture length or severity in some patients.
- Avoid prolonged attempts or excessive irrigation.
| | - Used to be performed 3 to 6 months post-injury for very short distraction defects.
- Associated with a high risk of stricture recurrence or injury to the rectum.
- Generally not recommended.
| - Performed 3 to 6 months post-injury.
- Our preferred approach to the majority of patients with a traumatic posterior urethral injury.
- Typically accomplished with a one-stage perineal anastomotic urethroplasty.
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