Background Urethral injury is traditionally managed with an initial suprapubic cystostomy and urethral reconstruction 3 – 6 months after. Early endoscopic urethral realignment may obviate the need for extensive urethral reconstruction and prevent complications resulting from the prolonged use of an indwelling catheter. Methods We reviewed our patients who had endosccopic urethral alignment for traumatic urethral distruption over a 42 month period. We used combined antegrade and retrograde rigid endoscopes for the procedure. The clinical and radiological details and complications were documented. Results Thirty-eight patients had endoscopic realignment of the urethra. Eighteen, 19 and 1 had anterior, posterior and female urethral injuries respectively. At follow up of 6 – 48 months (median 36 months), 9 (23.7%) patients with posterior urethral injuries developed strictures. Six patients with strictures from bulbomembraneous injury were successfully managed by internal urethrotomy and a regimen of clean intermitent self catheterization lasting for 1 month while 3 (including 2 with prostatomembraneous injury) had succesful anastomotic open urethroplasty following failed internal urethrotomy. No stictures was reported among patients with anterior urethral injury following endoscopic realignment. Two patients with prostatomembraneous urethral injury reported erectile dysfunction. No patient reported urinary incontinence.Conclusions This technique results in successful realignment of traumatic urethral distruptions and potentially prevent the development of strictures especially in the anteror urethra. Most patients who develop strictures in the posterior urethra are easily managed by internal urethrotomy followed by a short period of clean self intermittent catheterization. Introduction Urethral injuries are often described as rare in the literature [1-3]; it is frequently seen in our institution usually following motorcycle and motor vehicular road traffic accidents, and straddle injuries from poorly covered drainage channels [4]. It is a difficult injury to manage and there is no single method of treatment that is ideal [4, 5]. The traditional method of treatment is to insert a suprapubic catheter in the acute phase and then perform a delayed urethroplasty at least 3 months after the injury [2, 4, 6, 7]. Urethroplasty is often a very difficult and highly technical procedure to perform and many urologic surgeons are not particularly proficient with carrying out this difficult operation [1, 7]. In addition, delayed urethroplasty would also require that the patient would have an indwelling catheter for a prolonged period of time and with the attendant complications [8]. Open urethral realignment done soon after the injury is associated with a higher mortality and morbidity including bleeding, stricture, impotence and incontinence and therefore not often recommended [7, 9].Endoscopic realignment of the urethra is associated with high success rate, less morbidity and may avoid major surgery and prolonged catheterization [10]. Several methods of achieving endoscopic urethral realignment have been described [3, 11]. In our environment, endoscopic treatment of urethral disruption is still new with very few documented reports [5]. We make use of a combined antegrade and retrograde rigid endoscopic approach as a modification of previously described procedures [3, 11] to realign urethral disruptions that present to our institution. We aim to describe our method and the treatment outcome in the short-term. Materials and Methods Patients and preoperative managementAll patients with urethral injury who had endoscopic urethral realignment in our institution from April 2006 to September 2009 were reviewed. Patients with penetrating or open urethral injuries were excluded from the procedure.Preoperative careAfter paying attention to the immediate life-threatening injuries and conditions, the initial urologic treatment of the patients was to inser
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