Surgical Technique and Outcomes Following Posterior Urethral Reconstruction for Pelvic Fracture Urethral Injuries in a Low-income Country Setting.

OBJECTIVE

To evaluate outcomes of pelvic fracture urethral injury (PFUI) repair in Rwanda and identify factors associated with recurrence. PFUI management and outcomes in low and middle-income countries is understudied and remain poorly defined.

METHODS

We conducted a multicenter retrospective cross-sectional review of males who underwent surgical repair for PFUI in Rwanda from 2016 to 2023. The primary outcome was stricture recurrence at 3 months, defined as recurrent lower urinary tract symptoms with radiographic or cystoscopic evidence of stenosis. Univariable logistic regression was used to assess associations between clinical variables and recurrence.

RESULTS

Forty-seven patients were included (mean age 32.3 years) [SD: 14]. Median time to surgery was 1.4 years (IQR 0.5-3.5). Motor vehicle accidents (MVA) accounted for 61.7% of injuries. Excision and primary anastomosis were performed in 93.7% of patients, with 42.5% requiring crural splitting. At 3 months, 19.1% recurred. Preoperative urine culture status, defect length, fracture characteristics, operative approach, and surgical delay were not associated with recurrence. However, symptomatic urinary tract infection after catheter removal significantly increased recurrence risk (OR 13.3, P = .009). Postoperative urinary quality of life improved in all patients, with a mean improvement of 4.4 points, and 85% reported good-to-excellent outcomes. Complications were uncommon and mild (Clavien ≤2).

CONCLUSION

PFUI repair in Rwanda is feasible, with outcomes comparable to those of high-income settings. Despite limited resources, posterior urethroplasty provides durable results and meaningful quality-of-life improvements. Postoperative urinary tract infection may be a key risk factor for recurrence, suggesting a potential need to adapt perioperative antibiotic strategies in low- and middle-income countries environments.