Voiding dysfunction: Postsuccessful anastomotic urethroplasty for pelvic fracture urethral injury

Abstract

Introduction: Anastomotic urethroplasty (AU) is the standard of care for pelvic fracture urethral injuries (PFUIs). Few patients despite having successful AU have postoperative voiding dysfunction due to an unrecognized neurogenic bladder. This article outlines clinical signs which may predict these injuries. Materials and Methods: We retrospectively evaluated our database of more than 1000 cases. Patients who underwent successful AU with postoperative voiding dysfunction were included. The success of urethroplasty was determined by a retrograde urethrogram (RGU) and endoscopic evaluation. Voiding dysfunction was defined as patients with poor urine flow (Qmax <10 ml/s) postsurgery. Urodynamics (UDS) was performed postoperatively on all patients. Results: Six men were included with an average age of 27 years (all required step 3 AU). A RGU and endoscopy revealed a patent anastomosis. UDS showed neurogenic detrusor underactivity. There were variable occurrences of other lower motor neuron findings – muscle atrophy, fasciculations, sensory loss, areflexia, and fecal incontinence. The common factor was that all patients had a foot drop on preoperative assessment. Conclusions: Coexistent neurogenic bladder with PFUI is rare. The presence of foot drop and other lower motor neuron signs is a predictor for voiding dysfunction. We recommend these patients should have UDS before surgical repair and must be counseled accordingly.