Delayed Anastomotic Urethroplasty for Pelvic Fracture Urethral Injuries: 3-Month Outcome

Abstract

Introduction: Pelvic fracture urethral injuries (PFUI) complicates around 10% of all pelvic fractures. Many of these injuries end up with an obliterative defect, the so-called pelvic fracture urethral distraction defect (PFUDD). Delayed Anastomotic urethroplasty (DAU) offers the best results in such patients. No published study from Nepal has assessed the outcome of anastomotic urethroplasty for PFUI. The study was done to assess the 3-month outcome of DAU for PFUIs in the local set-up.

Method: The case records of patients with PFUIs who underwent DAU in Patan Hospital and Alka Hospital from 2015 April till 2017 December were retrospectively reviewed. Urethroplasty was done at least 3 months after the initial injury. Perurethral catheter was removed after 3-4 weeks of surgery. Data on patient demographics, operative details and outcome were recorded.

Result: Fourteen patients underwent DAU for PFUI. Mean age of the patients was 28.14 years (SD: 12.25). Road-traffic accidents (RTA) was the most common mode of injury (71.42%). Surgery was done at a median of 4 months after injury (interquartile range 4-7.75). Success rate, in terms of good urine flow and no requirement of intervention after surgery, was 100%. Three patients had complete absence of erection pre-op, while 1 patient had weak erection. One patient complained of loss of erection after surgery. All patients were fully continent after surgery.

Conclusion: A properly performed anastomotic urethroplasty for PFUDD is associated with an excellent outcome. Patients should be explained about the risk of post-operative erectile dysfunction.