Transperineal anastomotic urethroplasty for the treatment of pelvic fracture urethral distraction defects: a progressive surgical strategy

Purpose The aim was to reduce the difficulty of transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defect (PFUDD) and make it easy to master through an effective strategy. Patients and Methods Between January 2010 and December 2019, 1637 patients with PFUDDs were treated by transperineal anastomotic urethroplasty. The surgical strategy we used was the progressive transperineal anastomotic urethroplasty. First, after full mobilization of the distal bulbomembranous urethra, the stenotic urethra was transected directly at the proximal margin of the stenotic urethra to expose the proximal disrupted urethral end. Second, if the urethral stenosis location of some complicated cases was too deep to fully mobilize, the position of urethral transection was selected at the distal margin of the stenotic urethra. Then, the distal and proximal disrupted urethras were then trimmed and anastomosed without tension. A successful urethroplasty was defined as reestablishment of a uniform urethral caliber and no further interventions were needed. Results Follow-up was obtained in 1475 patients. The success rate was 92.4% (1363/1475). Among the 112 failed patients, 10 patients received endoscopic urethrotomy, 99 underwent a secondary or third anastomotic urethroplasty and 3 successfully treated with perineal skin flap urethroplasty. After final successful urethroplasty, 125 patients (8.5%) had different degrees of urinary incontinence and 15 (1.6%) developed de novo erectile dysfunction (1.6%). Conclusion The progressive transperineal anastomotic urethroplasty strategy was effective for treating PFUDD cases, improving surgical efficacy and reducing complications. It may contribute to standardizing the transperineal anastomotic urethroplasty and making it easy to master.