Transperineal urethroplasty for urethral distraction defects caused by pelvic fracture: Outcome analysis in 36 patients

Purpose: We report the outcomes of transperineal urethroplasty in patients with pelvic fracture urethral distraction defects (PFUDDs) over the past 12 years. Materials and Methods: Patients who received transperineal anastomotic repair of PFUDDs from January 2007 to December 2019 were retrospectively analyzed, specifically focusing on demographic findings, pelvic fracture type, urethral distraction defect length (based on retrograde urethrography and cystography), previous treatments, and ancillary maneuvers during surgery. Simultaneously, differences in clinical factors between successful and failed cases were also analyzed. Results: A total of 36 patients were included, with a final success rate of 83%. The mean age was 40.4 years, whereas the mean urethral distraction defect length was 31.9 mm. Most patients (69%) presented with unstable pelvic fractures. Treatment before referral included endoscopic treatment and urethroplasty in 13 (36%) and 2 cases (6%), respectively. For difficult cases, ancillary procedures, which included corporeal splitting (61.1%) and inferior pubectomy (8.3%), were performed. The postoperative average peak flow rate was 14.9 mL/s in the success group. Age and urethral defect length differed significantly between the success and failure groups. Conclusions: Over the past 12 years, transperineal urethral reconstruction demonstrated a success rate of 83% in 36 patients with PFUDD. Age and urethral defect length were identified as the two main factors affecting surgical prognosis.