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 preoperative 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.