Application of the prior exposure maneuvers urethroplasty in complex posterior anastomotic urethroplasty.

Abstract

Objectives: Current surgical interventions for pelvic fracture urethral injury (PFUI) are constrained by multiple limitations. This study aimed to introduce the prior exposure maneuvers urethroplasty (PEM-U) in complex posterior anastomotic urethroplasty for PFUI.

Methods: From February 2018 to March 2023 at Shanghai Ninth People's Hospital, 78 patients with complex PFUI underwent transperineal anastomotic urethroplasty, 39 patients of whom underwent classic Webster urethral urethroplasty in which bodies splitting or an inferior pubectomy after transection of bulbar urethra (Group A), and the other 39 patients underwent improved urethral urethroplasty (Group B), in which using PEM-U (corporeal bodies splitting or an inferior pubectomy before transection of bulbar urethra). Postoperative evaluations were performed at 1, 3, 6, and 12 months after catheter removal. Success was defined as a urine flow rate ≥15 mL/s, no difficulty in urination, and no further intervention was required.

Results: There was no statistical difference in the length of urethral defect between 39 patients (mean age 43.7 years) in Group A and 39 patients (mean age 41.3 years) in Group B. The average operation time of Group A was 115 min (range, 90-150 min), and that of Group B was 93 min (range, 85-115 min) (p = 0.012). The blood loss was 265 mL (range, 100-650 mL) in Group A and 214 mL (range, 90-350 mL) in Group B (p = 0.015). The success rate was 89.7% in the classical group and 92.3% in the improved group.

Conclusion: The PEM-U was effective for treating complex PFUI cases, improving surgical efficacy, reducing the operation time, and the amount of blood loss.