A direct vision urethrotome was used to incise the perineal membrane and join the proximal bulbous urethra to the dorsal prostate in 4 men with totally obliterated posterior urethras following pelvic fractures. All 4 patients have maintained patent urethras for 2 to 9 months. Progressive dilation has not been required in 3 men. A repeat internal urethrotomy was necessary in 1 patient who currently requires urethral sounding every 6 weeks. A comparison with 8 previous transpubic urethroplasties for the same surgical problem revealed a significant decrease in blood loss and hospital stay with direct vision urethrotomy. Transurethral incision of the obliterated posterior urethra following a crushing injury to the pelvis may be a reasonable initial procedure for restoring urethral continuity prior to more extensive urethroplasty.
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