Transperineal anastomotic urethroplasty with distal transection versus proximal transection: How to predict?

Abstract

Objectives: To evaluate the pubourethral stump angle (PUA) to determine the site of urethral transection during transperineal anastomotic urethroplasty (TAU).

Patients and methods: Patients diagnosed with pelvic fracture urethral distraction defect who underwent preoperative magnetic resonance (MR) urethrography and were treated with TAU between June 2019 and December 2021 were retrospectively reviewed. According to the site of urethral transection during TAU, patients were classified into proximal and distal groups receiving TAU with proximal and distal transection, respectively. The demographic and clinical data were recorded. The PUA was measured on sagittal T2-weighted MR urethrography. The relationship between the site of urethral transection and PUA was analyzed.

Results: Sixty-seven patients were included. Forty-one and 26 patients were included in the proximal and distal groups, respectively. Finally, the success rates in the proximal and distal groups were 95.1% and 92.3%, respectively. The PUAs were 123.7° ± 14.6° and 86.5° ± 9.8° (p = 0.005), respectively. The curves for the 2 groups intersected between 90° and 110°. The scribing effects at 90°, 100°, and 110° in the 2 groups were compared in detail. Compared with 90° and 110°, 100° had the highest sensitivity as the demarcation line.

Conclusions: In the treatment of pelvic fracture urethral distraction defect, the PUA on MR urethrography is an objective and valid parameter for evaluating the site of urethral transection during TAU. A PUA >100° indicates that proximal transection should be preferentially attempted.

Keywords

Pelvic fracture / Urethra / Anastomotic urethroplasty / Magnetic resonance / Urethrography

Acknowledgements

None.

Statement of ethics

This study was approved by the institutional review board of Shanghai Jiao Tong University Affiliated Sixth People's Hospital. No participant's consent was taken because 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

The authors declare no conflicts of interest.

Funding source

This study was supported by the National Natural Science Foundation of China (grant numbers: 82100707 and 82270707) and Shanghai Municipal Health Commission research project (grant number: 202140191).

Author contributions

LW, XL, YS: Participated in research design;

LW, WS, GC: Participated in the writing of the manuscript;

RL, CJ, ZL, YL: Participated in the performance of the research;

LW, XY 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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