Prostatomembranous urethral injuries: a review of the literature and a rational approach to their management.

Controversy surrounds the management of prostatomembranous urethral injuries. We herein present 38 patients and review the findings of 538 in 19 reported series. Results indicate a high risk of stricture, impotence and incontinence if conventional early urethral realignment techniques are used. Therefore, it is suggested that this approach be reserved for cases demanding immediate intervention (high riding bladder, associated rectal tear, concomitant bladder neck injury or continued bleeding), and that all others be managed by initial suprapubic cystostomy alone and delayed urethroplasty. Urethroplasty selection is discussed.