Long-term follow-up outcomes and independent predictors of surgical failure following posterior urethroplasty for pelvic fracture-associated urethral strictures.

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.