World journal of urology · 2026
Long-term follow-up outcomes and independent predictors of surgical failure following posterior urethroplasty for pelvic fracture-associated urethral strictures.
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Wang Jie, Huang Guanglin, Li Guizhong, Wang Jianwei
Аннотация
PURPOSE: To report long-term follow-up outcomes of posterior urethroplasty for pelvic fracture urethral strictures and identify independent predictors of surgical failure.
METHODS: We retrospectively enrolled patients who underwent delayed posterior urethroplasty for pelvic fracture urethral injury at our center between December 2018 and December 2024. Perioperative and follow-up data were collected and analyzed. Patients with less than 12 months of postoperative follow-up were excluded.
RESULTS: Seventy-six male patients were included. Median (IQR) age was 51.5 (40.5, 57.8) years. Injury mechanisms included crush trauma (n = 40, 52.6%), traffic accidents (n = 22, 29.0%), and falls (n = 14, 18.4%). Complete urethral obliteration was present in 54 patients (71.0%), and post-injury erectile dysfunction in 43 (56.6%). Thirty-two patients (42.1%) had prior urethral interventions. All procedures were successful. Median (IQR) urethral defect length was 2.5 (2.0, 3.5) cm. Direct anastomosis was performed in 48 patients (63.2%), and adjunctive maneuvers in 28 (36.8%). Median (IQR) follow-up was 30.0 (15.0, 59.5) months. Treatment success was achieved in 60 patients (79.0%), and failure in 16 (21.0%). On multivariate analysis, prior intervention (OR 11.558, 95% CI 1.356-98.515, P = 0.025) and longer urethral defect length (OR 4.394, 95% CI 1.262-15.292, P = 0.020) were independent predictors of surgical failure.
CONCLUSIONS: Posterior urethroplasty is safe and effective for pelvic fracture urethral strictures with favorable long-term functional outcomes. Prior intervention and longer urethral defect length are independent predictors of surgical failure.
METHODS: We retrospectively enrolled patients who underwent delayed posterior urethroplasty for pelvic fracture urethral injury at our center between December 2018 and December 2024. Perioperative and follow-up data were collected and analyzed. Patients with less than 12 months of postoperative follow-up were excluded.
RESULTS: Seventy-six male patients were included. Median (IQR) age was 51.5 (40.5, 57.8) years. Injury mechanisms included crush trauma (n = 40, 52.6%), traffic accidents (n = 22, 29.0%), and falls (n = 14, 18.4%). Complete urethral obliteration was present in 54 patients (71.0%), and post-injury erectile dysfunction in 43 (56.6%). Thirty-two patients (42.1%) had prior urethral interventions. All procedures were successful. Median (IQR) urethral defect length was 2.5 (2.0, 3.5) cm. Direct anastomosis was performed in 48 patients (63.2%), and adjunctive maneuvers in 28 (36.8%). Median (IQR) follow-up was 30.0 (15.0, 59.5) months. Treatment success was achieved in 60 patients (79.0%), and failure in 16 (21.0%). On multivariate analysis, prior intervention (OR 11.558, 95% CI 1.356-98.515, P = 0.025) and longer urethral defect length (OR 4.394, 95% CI 1.262-15.292, P = 0.020) were independent predictors of surgical failure.
CONCLUSIONS: Posterior urethroplasty is safe and effective for pelvic fracture urethral strictures with favorable long-term functional outcomes. Prior intervention and longer urethral defect length are independent predictors of surgical failure.