Reconstructive Urology| Volume 160, P203-209, February 2022

A Retrospective Look at Term Outcomes After Definitive Surgical Repair for Traumatic Pelvic Fracture Urethral Injuries – Does Initial Management Make a Difference?

Published:November 26, 2021DOI:



      To compare the long-term outcomes of initial management of pelvic fracture urethral injury (PFUI) in a large cohort of trauma patients undergoing urethral reconstruction.

      Materials and Methods

      119 patients underwent urethral reconstruction by a single surgeon for PFUI at our center between 1998-2018. We compared initial PFUI management - primary realignment vs suprapubic tube (SPT) insertion alone. Multivariable Cox proportional hazard analysis was used to assess the association between primary intervention and the risk of having a complication.


      PFUI was initially managed with primary realignment (57%) or SPT alone (43%). Ultimately, all patients underwent a primary perineal urethral anastomosis after a median of 7 months (IQR: 5-14). Overall, 27 patients (23%) had 1 or more long-term complications after a median 25 months (IQR:7-66), including urethral stricture, de novo erectile dysfunction, and urinary incontinence. On multivariable analysis, initial PFUI management did not predict for complications.


      No difference was found in long-term outcomes after urethral reconstruction when comparing initial PFUI management of primary realignment vs SPT insertion.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bjurlin MA
        • Fantus RJ
        • Mellett MM
        • et al.
        Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank.
        J Trauma. 2009; 67: 1033-1039
        • Brandes S
        • Borrelli Jr., J
        Pelvic fracture and associated urologic injuries.
        World J Surg. 2001; 25: 1578-1587
        • Andrich DE
        • Greenwell TJ
        • Mundy AR
        Treatment of pelvic fracture-related urethral trauma: a survey of current practice in the UK.
        BJU Int. 2005; 96: 127-130
        • Battaloglu E
        • Figuero M
        • Moran C
        • et al.
        Urethral injury in major trauma.
        Injury. 2019; 50: 1053-1057
        • Basta AM
        • Blackmore CC
        • Wessells H
        Predicting urethral injury from pelvic fracture patterns in male patients with blunt trauma.
        J Urol. 2007; 177: 571-575
        • Koraitim MM
        Pelvic fracture urethral injuries: the unresolved controversy.
        J Urol. 1999; 161: 1433-1441
        • Morey AF
        • Brandes S
        • Dugi 3rd, DD
        • et al.
        Urotrauma: AUA guideline.
        J Urol. 2014; 192: 327-335
        • Light A
        • Gupta T
        • Dadabhoy M
        • et al.
        Outcomes following primary realignment versus suprapubic cystostomy with delayed urethroplasty for pelvic fracture-associated posterior urethral injury: a systematic review with meta-analysis.
        Curr Urol. 2019; 13: 113-124
        • Zou Q
        • Zhou S
        • Zhang K
        • et al.
        The immediate management of pelvic fracture urethral injury-endoscopic realignment or cystostomy?.
        J Urol. 2017; 198: 869-874
        • Moudouni SM
        • Patard JJ
        • Manunta A
        • et al.
        Early endoscopic realignment of post-traumatic posterior urethral disruption.
        Urology. 2001; 57: 628-632
        • Boulma R
        • Kallel Y
        • Sellami A
        • et al.
        [Endoscopic realignment versus delayed urethroplasty in the management of post traumatic urethral disruption : report of 30 cases].
        Tunis Med. 2013; 91: 332-336
        • Ku JH
        • Jeon YS
        • Kim ME
        • et al.
        Comparison of long-term results according to the primary mode of management and type of injury for posterior urethral injuries.
        Urol Int. 2002; 69: 227-232
        • Onen A
        • Subasi M
        • Arslan H
        • et al.
        Long-term urologic, orthopedic, and psychological outcome of posterior urethral rupture in children.
        Urology. 2005; 66: 174-179
        • Fu Q
        • Zhang J
        • Sa YL
        • et al.
        Transperineal bulboprostatic anastomosis in patients with simple traumatic posterior urethral strictures: a retrospective study from a referral urethral center.
        Urology. 2009; 74: 1132-1136
        • Lumen N
        • Hoebeke P
        • Troyer BD
        • et al.
        Perineal anastomotic urethroplasty for posttraumatic urethral stricture with or without previous urethral manipulations: a review of 61 cases with long-term followup.
        J Urol. 2009; 181: 1196-1200
        • Kulkarni SB
        • Barbagli G
        • Kulkarni JS
        • et al.
        Posterior urethral stricture after pelvic fracture urethral distraction defects in developing and developed countries, and choice of surgical technique.
        J Urol. 2010; 183: 1049-1054
        • Flynn BJ
        • Delvecchio FC
        • Webster GD
        Perineal repair of pelvic fracture urethral distraction defects: experience in 120 patients during the last 10 years.
        J Urol. 2003; 170: 1877-1880
        • Webster GD
        • Ramon J
        Repair of pelvic fracture posterior urethral defects using an elaborated perineal approach: experience with 74 cases.
        J Urol. 1991; 145: 744-748
        • Kizer WS
        • Armenakas NA
        • Brandes SB
        • et al.
        Simplified reconstruction of posterior urethral disruption defects: limited role of supracrural rerouting.
        J Urol. 2007; 177 (Discussion 81-2): 1378-1381
        • Andrich DE
        • Dunglison N
        • Greenwell TJ
        • et al.
        The long-term results of urethroplasty.
        J Urol. 2003; 170: 90-92
        • Koraitim MM
        On the art of anastomotic posterior urethroplasty: a 27-year experience.
        J Urol. 2005; 173: 135-139
        • Singh SK
        • Pawar DS
        • Khandelwal AK
        • et al.
        Transperineal bulboprostatic anastomotic repair of pelvic fracture urethral distraction defect and role of ancillary maneuver: a retrospective study in 172 patients.
        Urol Ann. 2010; 2: 53-57