Abstract
We aimed to assess the surgical and patient-reported outcomes of delayed anastomotic urethroplasty (DAU) for pelvic fracture urethral injury (PFUI). We included 211 male patients who underwent DAU for PFUI. DAU success was considered when the urethral lumen was sufficiently large for the passage of a flexible cystoscope, without additional treatment required. The patients completed the lower urinary tract symptoms (LUTS)-related quality of life (QOL) questionnaire (scores: 0, not at all; 1, a little; 2, somewhat; 3, a lot), EuroQol-5 dimensions (EQ-5D), and EQ-5D visual analog scale (EQ-VAS). Postoperative overall satisfaction was evaluated using the following responses: “very satisfied,” “satisfied,” “unsatisfied,” or “very unsatisfied.” DAU was successful in 95.3% cases, with a median postoperative follow-up duration of 48 months. Multivariate logistic regression analysis revealed that “greater blood loss” was an independent predictor of failed urethroplasty. Questionnaire responses were obtained from 80.1% patients. The mean LUTS-related QOL, EQ-5D score and EQ-VAS improved significantly from 2.8, 0.63 and 54.4 at baseline to 0.9, 0.81 and 76.6 postoperatively (p < 0.0001 for all parameters). Moreover, 35.5% and 59.2% of the patients responded being “satisfied” and “very satisfied,” respectively, with their DAU outcomes. DAU not only had a high surgical success rate, but also a significant beneficial effect on both LUTS-related QOL and overall health-related QOL.
Highlights
Pelvic fracture urethral injury (PFUI) is a rare injury associated with pelvic fractures caused by blunt force [1,2]
This article presents an updated series of delayed anastomotic urethroplasty (DAU) for PFUI; we aimed to evaluate its effectiveness with respect to surgical and patient-reported outcomes
Suprapubic tube (SPT) was performed in patients with decreased urinary stream or urinary retention due to interruption resulting from urethral manipulations, including direct vision internal urethrotomy (DVIU) or urethral dilatation
Summary
Pelvic fracture urethral injury (PFUI) is a rare injury associated with pelvic fractures caused by blunt force [1,2]. PFUI itself is not lethal, it can cause urinary retention and sepsis due to urine extravasation in the acute phase. It can cause significant morbidity, including urethral gap, erectile dysfunction (ED), and urinary incontinence (UI) [1]. In 2019, we reported the outcomes of 115 patients with DAU who visited our hospital within the past 10 years [12]. This article presents an updated series of DAU for PFUI; we aimed to evaluate its effectiveness with respect to surgical and patient-reported outcomes
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