Preliminary Evaluation of Nontransecting Anastomotic Urethroplasty for Pelvic Fracture Urethral Injury: Insights From a Comparison With Excision and Primary Anastomosis

Abstract

Objectives

To evaluate the feasibility and surgical and patient-reported outcomes of nontransecting anastomotic urethroplasty (NTAU) for male patients with pelvic fracture urethral injury (PFUI) compared with excision and primary anastomosis (EPA), the current mainstay surgical approach.

Methods

This retrospective study analyzed 233 male PFUI patients treated with EPA (n = 223) or NTAU (n = 10) from 2008 to 2024 by a single surgeon (AH). NTAU involves preserving urethral continuity and maintaining bilateral bulbar artery integrity while excising scar tissue and achieving tension-free urethral anastomosis. Anatomical success was defined as the ability to pass a 17Fr flexible cystourethroscope through the anastomotic site without resistance and no need for additional treatments. Postoperative functional outcomes were assessed using validated patient-reported measures, including the LUTS-specific quality-of-life (QOL) questionnaire, the Sexual Health Inventory for Men (SHIM), and the EuroQol Visual Analog Scale (EQ-VAS).

Results

Although the median follow-up period was significantly shorter for NTAU (12 vs. 69 months, p < 0.0001), the anatomical success rate was 100% for NTAU and 94.6% for EPA, with no significant difference between the groups (p = 0.45). No significant differences were observed in the perioperative complication rate (p = 0.54). The changes in LUTS-QOL, SHIM, and EQ-VAS scores from preoperative to postoperative assessments were also comparable, indicating similar patient-reported outcome improvements in both groups (p = 0.71, p = 0.16, p = 0.92, respectively).

Conclusion

NTAU has the potential to achieve surgical and patient-reported outcomes comparable to EPA. Further studies are warranted to validate its long-term benefits and define its optimal indications.