Outcomes of early endoscopic realignment for pelvic fracture urethral injury

Abstract

Introduction: Post-traumatic rupture of the posterior urethra is a serious injury that can compromise the micturition and erectile prognosis of the often-young patient. The management of this lesion is still controversial, leaving the choice between early endoscopic realignment or suprapubic catheterization with deferred urethroplasty. The objective of this study was to report our clinical experience and outcomes with early endoscopic realignment (EER) for patients with pelvic fracture urethral injury. Patients and Methods: We underwent a retrospective review of patients with pelvic fracture associated urethral injury who underwent EER from 2010 to 2020. Preoperative, perioperative, and postoperative outcome data were collected. Complications for the surgical procedure was analyzed, as well as post-operative stenosis, urinary incontinence and erectile dysfunction. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow up. Results: A total of 26 patients underwent primary endoscopic realignment. The median duration from injury to EER was 15.4 ± 10.25 hours. No patient experienced complications from endoscopic realignment. EER was successful in 16 patients (61.53%) at a median follow up of 34 months (18–54). Ten patients (38.46%) developed a urethral stricture during follow up. Seven patients (26.92%) were treated by one or two direct visual internal urethrotomy. Only 3 patients (11.53%) required urethroplasty. There were no urethroplasty failure after previous EER. Two patients (7.69%) reported stress urinary incontinence after EER. Four patients (15.88%) developed de novo erectile dysfunction. Conclusion: Early endoscopic realignment allows some patients to avoid a heavier surgical treatment, and doesn’t compromise the realization of a later urethroplasty.