Scholarlink

Purpose <p>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.</p> Methods <p>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.</p> Results <p>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, <i>p</i> = 0.007) and persistent extravasation (HR = 6.36, <i>p</i> = 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%.</p> Conclusions <p>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.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

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

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年8月1日

查看全文
  • Natalia Plamadeala,
  • Marjan Waterloos,
  • Mieke Waterschoot,
  • Nicolaas Lumen

摘要

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.