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. 2025 Aug 1;43(1):469.
doi: 10.1007/s00345-025-05839-3.

Posterior urethroplasty for pelvic fracture urethral injuries: risk factors for recurrence and complications

Natalia Plamadeala  1   2 , Marjan Waterloos  3   4 , Mieke Waterschoot  3 , Nicolaas Lumen  3
Affiliations

Posterior urethroplasty for pelvic fracture urethral injuries: risk factors for recurrence and complications

Natalia Plamadeala et al. World J Urol. .

Abstract

Purpose: Surgical reconstruction for posterior urethral injuries associated with pelvic fractures (PFUI) is complex. Perineal posterior urethroplasty via excision and primary anastomosis (EPA) is the standard treatment. This study evaluates risk factors for stenosis recurrence after primary EPA and analyzes predictors of postoperative complications.

Methods: A retrospective analysis was conducted on male patients who underwent primary posterior EPA for PFUI at Ghent University Hospital (2001-2024). The primary outcome was stenosis recurrence at 1-, 2-, and 10-year follow-up, defined as urethral narrowing causing obstructive symptoms and requiring intervention. Demographic data, prior urethral manipulation, surgical techniques, 90-day complications (Clavien-Dindo), and functional outcomes were analyzed. Univariate and multivariate coxregression analyses were performed using IBM SPSS Statistics v. 29.0.2.0.

Results: Among 70 patients, 75.5% underwent transecting EPA. After a median follow-up of 130 months (IQR 78.5-178.5), stenosis recurrence occurred in 15.8% at a median of 3 months (IQR 2.0-5.0). The 1-, 2-, and 10-year recurrence-free survival rates were 85.4%, 83.8%, and 83.8%, respectively. In multivariate analysis, postoperative complications (HR = 4.85, p = 0.007) and persistent extravasation (HR = 6.36, p = 0.006) significantly increased recurrence risk. Postoperative complications (21.4%) were all low-grade and managed conservatively. Erectile function was impaired in 97.9% due to trauma, with 12.2% improving postoperatively. De novo urinary incontinence occurred in 6.6%.

Conclusions: Posterior urethroplasty demonstrates a high long-term success rate in patients with PFUI. Postoperative complications and persistent urinary leakage significantly increase the risk of surgical failure, highlighting the need for rigorous follow-up. The non-transecting technique, when possible, does not negatively impact outcomes.

Keywords: Pelvic fracture urethral injury; Posterior urethroplasty; Stenosis recurrence; Urethral reconstruction; Urethroplasty complications.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of of UZ Ghent, Ghent University Hospital, (Protocol Number EC/UZG/2008/234). Informed consent: Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the patient(s) to publish this paper.

Figures

Fig. 1
Fig. 1
Preoperative retrograde urethrography, voiding cystourethrography, and MRI
Fig. 2
Fig. 2
Transecting excision and primary anastomosis technique: a Splitting of the corpora cavernosa; b urethral transection; c spatulation of the proximal urethral end; d spatulation of the distal urethral end; e dorsal urethral plate anastomosis
Fig. 3
Fig. 3
Vessel sparing (yellow arrow) in the non-transecting excision and primary anastomosis technique
Fig. 4
Fig. 4
The overall number of complications in the study cohort (total of 18 complications, 25.7%)
See this image and copyright information in PMC

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References

    1. Barratt RC, Bernard J, Mundy AR, Greenwell TJ (2018) Pelvic fracture urethral injury in males—mechanisms of injury, management options and outcomes. Transl Androl Urol 7:S29–S62 - PMC - PubMed
    1. Johnsen NV, Kaufman MR, Dmochowski RR, Milam DF (2018) Erectile dysfunction following pelvic fracture urethral injury. Sex Med Rev 6:114–123 - PubMed
    1. Ballesteros Ruiz C, Toribio-Vázquez C, Fernández-Pascual E, Ríos E, Rodríguez Serrano A, Alonso Dorrego JM, De Girón M, Moreno JA (2022) Cárcamo Valor P, Martínez-Piñeiro L. Repair of Traumatic Urethral Strictures: La Paz University Hospital Experience. JCM 12:54 - PMC - PubMed
    1. Clark SS, Prudencio RF (1972) Lower urinary tract injuries associated with pelvic fractures: diagnosis and management. Surg Clin North Am 52:183–201 - PubMed
    1. Shenfeld OZ, Kiselgorf D, Gofrit ON, Verstandig AG, Landau EH, Pode D (2003) The incidence and causes of erectile dysfunction after pelvic fractures associated with posterior urethral disruption. J Urol 169:2173–2176 - PubMed