A Retrospective Look at Term Outcomes After Definitive Surgical Repair for Traumatic Pelvic Fracture Urethral Injuries – Does Initial Management Make a Difference?

• Published in: Urology (Ridgewood, N.J.) N.J.), 2022-02, Vol.160, p.203-209
• Main Authors: Neu, Sarah, Remondini, Taylor, Hird, Amanda, Locke, Jennifer A., Herschorn, Sender, Kodama, Ronald
• Format: Article
• Language: English
• Subjects: Female; Fractures, Bone - complications; Fractures, Bone - surgery; Humans; Male; Pelvic Bones - injuries; Retrospective Studies; Urethra - injuries; Urethra - surgery; Urethral Stricture - complications; Urethral Stricture - surgery
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2021.10.036

To compare the long-term outcomes of initial management of pelvic fracture urethral injury (PFUI) in a large cohort of trauma patients undergoing urethral reconstruction. 119 patients underwent urethral reconstruction by a single surgeon for PFUI at our center between 1998-2018. We compared initial PFUI management - primary realignment vs suprapubic tube (SPT) insertion alone. Multivariable Cox proportional hazard analysis was used to assess the association between primary intervention and the risk of having a complication. PFUI was initially managed with primary realignment (57%) or SPT alone (43%). Ultimately, all patients underwent a primary perineal urethral anastomosis after a median of 7 months (IQR: 5-14). Overall, 27 patients (23%) had 1 or more long-term complications after a median 25 months (IQR:7-66), including urethral stricture, de novo erectile dysfunction, and urinary incontinence. On multivariable analysis, initial PFUI management did not predict for complications. No difference was found in long-term outcomes after urethral reconstruction when comparing initial PFUI management of primary realignment vs SPT insertion.