The management of complete or partial posterior urethral disruption is controversial and much debate continues regarding the immediate, early and delayed definitive therapy. We report our institutional experience and long term result of early endoscopic realignment of traumatic posterior urethral injury.

Retrospective data had been collected between October 2022 and January 2025, forty six (46) men with either complete (35) or partial (11), posterior urethral injury secondary to blunt trauma (16) or pelvic fractures (30), presented to our institution and these patients underwent immediate suprapubic cystostomy followed by early primary endoscopic realignment done 3-8 days after injury.

35 patients (76.08%) were continent after catheter removal. Urethral stricture was seen in thirty four patients (73.9%) of which twenty three patients (67.6%) had simple urethral stricture who were managed by urethral dilatation on outpatient basis. six patients (17.6%) developed short strictures which were successfully treated with visual internal urethrotomy. Five patients (14.7%) required anastomotic urethroplasty for dense stricture. Potency was retained in thirty two patients (69.5%). Urinary flow measurements at follow-up evaluation were satisfactory.

Early primary endoscopic realignment reduces the time to spontaneous voiding, minimizes the need for major reconstructive surgery, and decreases the likelihood of requiring long-term suprapubic urinary diversion.