Redo inferior pubectomy for failed anastomotic urethroplasty in pelvic fracture urethral injury

Abstract

Objectives: To assess the effect of redo inferior pubectomy on the management of complicated pelvic fracture urethral injury (PFUI) in patients with a history of failed anastomotic urethroplasty.

Materials and methods: We retrospectively reviewed all patients receiving redo anastomotic urethroplasty with redo inferior pubectomy for failed PFUI between January 2010 and December 2021. Patients with incomplete data and those who were lost to follow-up were excluded. Successful urethroplasty was defined as the restoration of a uniform urethral caliber without stenosis or leakage and further intervention. Functional results, including erectile function and urinary continence, were evaluated. Descriptive statistical analyses were then performed.

Results: Thirty-one patients were included in this study. Among them, concomitant urethrorectal fistula occurred in 2 patients, and concomitant enlarged bladder neck occurred in 1. The stenosis site was the bulbomembranous urethra in 2 patients and the prostatomembranous urethra in 29. The mean length of urethral stenosis in all patients was 3.1 cm (range, 2.0-5.0 cm). After a mean follow-up of 34.6 months, the final success rate was 96.8%. The incidence of erectile dysfunction reached 77.4% (24/31). Normal continence was achieved in 27 (87.1%) patients. One patient developed urinary incontinence of grade II requiring urinary pads because of an enlarged bladder neck. According to the Clavien-Dindo classification, postoperative complications of grade I occurred in 7 patients and grade II in 4.

Conclusions: Repeat anastomotic urethroplasty with repeat inferior pubectomy provides reliable success rates for failed PFUI. In complicated cases, it should be known and mastered.

Keywords

Pelvic fracture / Urethral injury / Urethroplasty / Inferior pubectomy / Redo

Author summay

Lin Wang and Wenxiong Song contributed equally to this article.

Supplemental Digital Content is available for this article.

Acknowledgments

None.

Statement of ethics

This study was approved by the Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiao Tong University. No participant’s consent was taken, for it was a retrospective review on the electronic database. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest statement

XL is amember of the early career editorial board of Current Urology. This article was accepted after a normal external review. No conflict of interest has been declared by the other authors.

Funding source

This study was supported by the National Natural Science Foundation of China (no. 82100707 and 82270707) and Shanghai Municipal Health Commission research project (no. 202140191).

Author contributions

LW, YL, YS: Participated in research design; LW, WS, XP: Participated in the writing of the manuscript; RL, JW, CJ, CF, YL: Participated in the performance of the research; and LW, XL: Participated in data analysis.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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