A retrospective look at term outcomes after definitive surgical repair for traumatic pelvic fracture urethral injuries - does initial management make a difference?

ABSTRACT Objective 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 centre between 1998-2018. We compared initial PFUI management - primary re-alignment versus 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. Results 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 one 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. Conclusions No difference was found in long-term outcomes after urethral reconstruction when comparing initial PFUI management of primary re-alignment versus SPT insertion.