Prognosis of urethral strictures following pelvic fracture urethral distraction defects–A single centre study

Abstract

Introduction Urethral strictures remain a reconstructive dilemma due to high incidence of recurrence and unsatisfactory outcomes. Pelvic trauma remains the foremost etiology leading to morbidity. We evaluated this “ cause-effect” relationship of pelvic trauma to stricture outcome, to replenish our understanding of contemporary urethral strictures and highlight significance of type, degree and influence of primary management of pelvic trauma on the overall prognosis of urethral strictures. Materials and method 163 male patients with urethral strictures, primary etiology being pelvic trauma, were assessed preoperatively followed by retrograde urethrogram, urethrosonogram, uroflowmetry, and then subjected to pelvic radiographs to identify presence and type of pelvic fracture, and further sub-categorize them into grades A, B and C, of TILE classification. Thereafter, 6 weeks later, these patients underwent urethroplasty. Results Of 163 patients having pelvic trauma, 80 fell under category A of TILE grading, whereas 55 were under TILE B and 28 under TILE C. Most common stricture location was membranous urethra. Success rates were 96–98% till 1 year follow up, but after two years, they declined to 93%. TILE A and B had a better post operative course as compared to TILE C. Overall complication rate was 20.25%. Conclusion The magnitude of the impact of the type of pelvic fracture and its management has remained unexplored. Our representative study enunciates that these parameters play a vital role in the overall prognosis of urethral strictures and command due importance, to bridge the rift in this “ cause-effect” relationship.