Long-term outcomes of anastomotic urethroplasty for pelvic fracture urethral injury. The experience of a decade at Sindh Institute of Urology and Transplantation

Abstract

Objective: To determine the long-term outcomes of anastomotic urethroplasty in cases of pelvic fracture urethral injury.

Method: The retrospective study was conducted at a tertiary care hospital in Karachi, and comprised data from January 1, 2011, to December 31, 2020, related to all patients who had undergone anastomotic urethroplasty for pelvic fracture urethral injury. Clinical data as well as patient-reported outcomes were noted using a predesigned questionnaire. One-year follow-up data of those who expired was not used for analysis. Data was analysed using SPSS 22.

Results: Of the 440 patients with mean age 28.70±12.50 years, 2(0.45%) expired. Among the 438(99.55%) cases, success was observed in 350(79.9%). Spontaneous return of good erection was seen in 137 (60.2%) of men, irrespective of the outcome of anastomotic urethroplasty. A successful case was found to have 35 (7.8%) fertility. Most patients reported high satisfaction with quality of life, surgical results, and genital appearance, while sexual performance and pain showed mixed outcomes.

Conclusion: Anastomotic urethroplasty was found to be effective in providing long-term restoration of urine flow. Improvement in erectile function, and restoration of fertility were seen in long-term successful cases.

Key Words: Pelvic fracture urethral injury, Anastomotic urethroplasty, Excision and primary anastomosis, EPA, Crural division, Inferior partial pubectomy, Progressive abdomino-perineal approach, Pelvic trauma, Urethral trauma.