Outcome of patients with failed pelvic fracture-associated urethral injury repair: A single centre 10-year experience

Özet

Objective: The management of recurrent posterior urethral strictures developing after pelvic fracture urethral injury (PFUI) is a challenging task. Despite availability of many surgical approaches, there is no consensus regarding the optimal approach. The objective of this study was to present our 10-year experience inthe management of recurrent urethral strictures due to PFUI.Material and methods: We did a retrospective single-institution review of patients who underwent surgicalmanagement for recurrent posterior urethral strictures from January 2006 to December 2016 using descriptive statistics. We included only those patients with PFUI who underwent some definitive surgical procedurefor their previous failed repair(s).Results: The final analysis included data of 50 male patients (10 adolescents and 40 adults). Mean age ofthe patients was 29.92±10.62 years. The average length of stricture was 3.02±1.47 cm. Progressive perinealurethroplasty (PPU) was done in 40 cases. Two patients with concomitant rectourethral fistula/false passageunderwent transpubic urethroplasty (TPU). Three patients with complete bulbar necrosis were managedwith single stage/staged preputial tube reconstruction. One patient underwent microsurgical urethroplastyusing radial free forearm flap while in two patients each Mitrofanoff appendicovesicostomy and perinealurethrostomy was done. Majority of complications were minor (Clavien Grade 1 and 2). Overall success rateof PPU was 75%. Mean follow-up period was 29.46±10.68 months (range: 13-60 months).Conclusion: Most cases of recurrent posterior urethral strictures of <3 cm in length can be operated by PPUwith reasonable success rates. Complex and long-segment (higher than 3 cm) strictures require use of ancillary procedures like TPU, substitution urethroplasty and Mitrofanoff appendicovescostomy.