Abstract: PD29-10
Sources of Funding: none

Introduction

Delayed urethroplasty for pelvic fracture urethral injury (PFUI) remains a clinical challenge in part because it may not be possible to predict from urethrography or urethroscopy findings the type of repair required. We therefore examined whether the type of reconstruction needed for PFUI repair can be predicted from preoperative magnetic resonance imaging (MRI) findings.

Methods

The records of 74 male patients with PFUI who underwent MRI of the pelvis at least 3 months after injury and, subsequently, anastomotic urethroplasty by a single surgeon (AH) during 2008 and 2015 were analyzed retrospectively. Pubo-urethral stump angle (PUA) was defined as the angle, measured in sagittal T2-weighted MRI, between the long axis of the pubis and the line between the lower border of the inferior pubic ramus and the proximal urethral stump. MRI findings including PUA were reviewed by two expert radiologists (HE and SS) without any knowledge of the patients&[prime] clinical information. The association of MRI findings and the procedures required during delayed urethroplasty was analyzed.

Results

Delayed urethroplasty was performed by the simple perineal approach in the 28 patients (38%) who required only bulbar urethral mobilization with/without crural separation and by an elaborate approach in the 46 patients (62%) who additionally required inferior pubectomy or an abdominoperineal approach. The overall success (defined as no recurrent stricture on urethroscopy) rate was 94.6%. MRI findings that in univariate analysis were significantly associated with a need for the elaborate approach were disruption at the prostate apex (p = 0.001), greater urethral defect length (p < 0.0001), lower ratio of bulbar urethral length to urethral defect length (p = 0.0005), presence of a paraurethral false passage (p = 0.0257), longer distance between the lower border of the inferior pubic ramus and the proximal urethral stump (< 0.0001), and lower PUA (p < 0.0001). MRI findings not significantly associated with a need for the elaborate approach were the bulbar urethral length (p = 0.69), lateral displacement of prostatic urethra (p = 0.19), and bulging of the rectum into the urethral gap (p = 0.15). In multivariate analysis, only low PUA was an independent predictor of a need for the elaborate perineal approach (p=0.045, OR=4.8, 95% CI 1.0-25.5).

Conclusions

PUA measured on MRI could provide information useful for predicting the type of reconstruction needed for PFUI repair.

Funding

none