Abstract: PD29-09
Sources of Funding: none

Introduction

Anastomotic urethroplasty (AU) for pelvic fracture urethral injury (PFUI) is a challenging procedure, notably, if corporeal splitting and/or inferior pubectomy (CS/IP) are required. Consequently, a long learning curve is surely needed. Herein, we used retrograde urethrogram (RGU) to envisage the intraoperative difficulty during AU for PFUI. We hypothesized that as deep as the urethra goes into the pelvis, the more complexity is anticipated.

Methods

A retrospective review for patients underwent AU for PFUI at a tertiary referral center was conducted between January 2010 and March 2016. The standard position for RGU is semi-lateral with only one obturator foramen is visualized. To address how deep the urethra goes into the pelvis, an imaginary line is drawn from the pubis symphysis down to a point midway between the tips of pubic rami, representing theoretically the midsagittal plane of the perineal membrane. Zones where the proximal end of the anterior urethra is present, are (A) anterior to the line, (B) on the line, and (C) across the line posteriorly (Fig.). The complexity of the procedure was defined as the need of any auxiliary maneuver beyond distal urethral mobilization (CS/IP) to achieve adequate anastomosis. Predictors were tested only in patients with successful AU. Further analysis was performed to detect the association between this hypothesis and the outcome defined by the need for instrumentation after AU.

Results

129 patients were analyzed. 39 (30%) patients required auxiliary procedures beyond mobilization of the distal urethra and 36 (27.9%) reported failure. Among patients with successful AU, zone C was the only factor significantly associated with complex AU [13 (44.8%) vs 12 (18.8%)]. Furthermore, zone C [Odds ratio (OR): 4.9, p=0.006], as well as combined pelvic fracture (OR: 4.6, p=0.009), were the only independent predictors of treatment failure.

Conclusions

We defined a simple method to predict intraoperative complexity and treatment failure after AU for PFUI. This is might be of help for_x000D_ preoperative counseling and intraoperative planning by selecting cases for training and reserving particular ones for high volume_x000D_ surgeons.

Funding

none