A Study of the Outcome of Anastomotic Urethroplasty as a Delayed Management of Traumatic Posterior Urethral Injury

Open Access

Abstract

Background: Pelvic fracture-associated posterior urethral injuries are complex reconstructive problems that require delayed surgical repair. Anastomotic urethroplasty remains the gold standard, although its outcomes are multifactorial. This study was aimed at assessing the surgical outcomes and the predictors of failure after delayed anastomotic urethroplasty for post-traumatic posterior urethral strictures. Materials & Methods: This observational study was conducted at Dhaka Medical College Hospital from March 2017 to March 2018, including 50 adult male patients who had complete post-traumatic posterior urethral obliteration and underwent delayed anastomotic urethroplasty. A transperineal approach with spatulated mucosa-to-mucosa anastomosis was done for all cases, with the addition of inferior pubectomy when the urethral gap exceeded 3 cm. Surgical success was defined as asymptomatic voiding with adequate flow and no radiological narrowing. Patients were followed up after 3, 6, and 12 months with uroflowmetry and urethrography. Data were entered and analyzed using SPSS version 26. Results: The mean patient age was 32.8±13.9 years, with road traffic accidents accounting for 74% of injuries. Mean stricture length was 2.7±0.9 cm, and mean time to repair was 12.4±3.1 weeks. Surgical success was achieved in 86% of patients, with overall complications occurring in 36%. Stricture length >3 cm (adjusted OR 8.74, p=0.005) and performance of inferior pubectomy (adjusted OR 3.62, p=0.048) were independent predictors of surgical failure. Mean postoperative Qmax was significantly higher in successful repairs compared to failures (20.4±3.9 vs 12.8±2.5 ml/s, p<0.001). Conclusion: Delayed anastomotic urethroplasty provides good results in post-traumatic posterior urethral strictures, with a success rate of 86%. The failure rate is higher in longer strictures and in cases requiring inferior pubectomy. Proper patient selection and planning are essential.