Flexible cystoscope for evaluating pelvic fracture urethral distraction defects.

OBJECTIVE To describe the value of flexible cystoscopy versus conventional urethrography (retrograde urethrography and cystourethrography) in diagnosing pelvic fracture urethral distraction defects (PFUDDs). PATIENTS AND METHODS Between May 2010 and June 2011, 120 male patients with PFUDDs were evaluated. In this study, all patients underwent conventional urethrography after admission. Flexible cystoscopy was also used for comparison, followed by conventional urethrography. The flexible cystoscope was introduced into the posterior urethra and the area was evaluated for the length of the proximal urethra and any possible fistulas, false passages, calculi or displacement of the posterior urethra. RESULTS Severe allergic reaction or obvious discomfort did not occur in any patients after conventional urethrography or flexible cystoscopy. By comparing the data obtained from flexible cystoscopy to those from conventional urethrography, no statistical difference was found in the measured length of the proximal posterior urethra (4.31 ± 2.28 vs. 4.02 ± 3.12, p > 0.05). However, the rate of detection in other abnormalities was higher in flexible cystoscopy than in conventional urethrography (48.3 vs. 10.8%, p < 0.05). Seventeen (14.2%), 9 (7.5%) and 32 (26.7%) patients were detected with fistula, false passage and calculus, respectively, according to flexible cystoscopy. In comparison, fistula, false passage and calculus were only observed in 2 (1.7%), 7 (5.8%) and 4 (3.3%) patients, respectively, through conventional urethrography imaging. CONCLUSIONS Flexible cystoscopy is a valuable procedure in the evaluation of the posterior urethra and bladder neck, and in patients with urethral distraction defects before surgery. More details about fistulas, false passages, calculi and urethral defects could be obtained through this method.