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Multicenter analysis of posterior urethroplasty complexity and outcomes following pelvic fracture urethral injury

  • Original Article
  • Published:
World Journal of Urology Aims and scope

Abstract

Purpose

To analyze outcomes of posterior urethroplasty following pelvic fracture urethral injuries (PFUI) and to determine risk factors for surgical complexity and success.

Methods

Patients who underwent posterior urethroplasty following PFUI were identified in the Trauma and Urologic Reconstructive Network of Surgeons (TURNS) database. Demographics, injury patterns, management strategies, and prior interventions were evaluated. Risk factors for surgical failure and the impact of ancillary urethral lengthening maneuvers (corporal splitting, pubectomy and supracrural rerouting) were evaluated.

Results

Of the 436 posterior urethroplasties identified, 122 were following PFUI. 83 (68%) patients were acutely managed with suprapubic tubes, while 39 (32%) underwent early endoscopic realignment. 16 (13%) patients underwent pelvic artery embolization in the acute setting. 116 cases (95%) were completed via a perineal approach, while 6 (5%) were performed via an abdominoperineal approach. The need for one or more ancillary maneuvers to gain urethral length occurred in 4 (36%) patients. Of these, 44 (36%) received corporal splitting, 16 (13%) partial or complete pubectomy, and 2 (2%) supracrural rerouting. Younger patients, those with longer distraction defects, and those with a history of angioembolization were more likely to require ancillary maneuvers. 111 patients (91%) did not require repeat intervention during follow-up. Angioembolization (p = 0.03) and longer distraction defects (p = 0.01) were associated with failure.

Conclusions

Posterior urethroplasty provides excellent success rates for patients following PFUI. Pelvic angioembolization and increased defect length are associated with increased surgical complexity and risk of failure. Surgeons should be prepared to implement ancillary maneuvers when indicated to achieve a tension-free anastomosis.

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Author information

Authors and Affiliations

  1. Departments of Urology, University of Washington, Seattle, WA, USA

    Niels Vass Johnsen & Bryan B. Voelzke

  2. University of Utah, Salk Lake City, UT, USA

    Rachel A. Moses & Jeremy B. Myers

  3. University of Minnesota, Minneapolis, MN, USA

    Sean P. Elliott

  4. Lahey Hospital and Medical Center, Burlington, MA, USA

    Alex J. Vanni

  5. University of California San Francisco, San Francisco, CA, USA

    Nima Baradaran & Benjamin N. Breyer

  6. University of California, San Diego, USA

    Garrick Greear & Jill C. Buckley

  7. Baylor College of Medicine, Houston, TX, USA

    Thomas G. Smith III

  8. New York University, New York, NY, USA

    Michael A. Granieri & Lee C. Zhao

  9. Uropartners, Gurnee, IL, USA

    Nejd F. Alsikafi

  10. University of Iowa (BAE), Iowa City, IA, USA

    Bradley A. Erickson

  11. Harborview Medical Center, Box 359868, 325 Ninth Ave, Seattle, WA, 98104, USA

    Niels Vass Johnsen

Authors
  1. Niels Vass Johnsen
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  2. Rachel A. Moses
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  3. Sean P. Elliott
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  4. Alex J. Vanni
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  11. Jeremy B. Myers
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  15. Bryan B. Voelzke
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Consortia

For the Trauma Urologic Reconstruction Network of Surgeons(TURNS)

Contributions

NVJ: project development, data collection/management, data analysis, manuscript writing/editing. RAM: data collection, manuscript editing. SPE: data collection/management, manuscript editing. AJV: data collection/management, manuscript editing. NB: data collection, manuscript editing. GG: data collection, manuscript editing. TGS: data collection/management, manuscript editing. MAG: data collection, manuscript editing. NFA: data management, data analysis, manuscript editing. BAE: data management, data analysis, manuscript editing. JBM: data management, data analysis, manuscript editing. BNB: data management, data analysis, manuscript editing. JCB: data management, data analysis, manuscript editing. LCZ: data management, data analysis, manuscript editing. BBV: project development, data management, data analysis, manuscript editing

Corresponding author

Correspondence to Niels Vass Johnsen.

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The authors declare that they have no conflict of interest.

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:All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with animals performed by any of the authors.

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Johnsen, N.V., Moses, R.A., Elliott, S.P. et al. Multicenter analysis of posterior urethroplasty complexity and outcomes following pelvic fracture urethral injury. World J Urol 38, 1073–1079 (2020). https://doi.org/10.1007/s00345-019-02824-5

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  • DOI: https://doi.org/10.1007/s00345-019-02824-5

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