• Akio Horiguchi, Masayuki Shinchi, Ayako Masunaga, Kazuki Okubo, Kazuki Kawamura, Kenichiro Ojima, Keiichi Ito, Tomohiko Asano, and Ryuichi Azuma.
• Department of Urology, National Defense Medical College, Saitama, Japan. Electronic address: impreza@ndmc.ac.jp.
• Urology. 2017 Oct 1; 108: 184-189.

ObjectiveTo compare the clinical courses of patients with pelvic fracture urethral injury (PFUI) according to initial management strategy.MethodsWe reviewed the clinical courses of 63 patients with PFUI who were initially treated elsewhere and underwent delayed anastomotic urethroplasty by a single surgeon between 2008 and 2015. Patients were grouped according to their initial treatment: by suprapubic tube placement alone (49 patients, SPT group) or primary realignment (14 patients, PR group). Time to urethroplasty was defined as the period between injury and delayed urethroplasty. Clinical data regarding the status of urethral stenosis, urethroplasty procedure, and treatment outcome were analyzed.ResultsThe mean time to urethroplasty in the PR group was about 3 times than that in the SPT group (133 months vs 47 months, P = .035). Fifty percent of the PR group (7 of 14) had a history of repeated urethrotomy or dilation before referral, a percentage significantly higher than that of the SPT group (20.4%, 10 of 49, P = .027). The percentage of patients having a false passage and iatrogenic scar was significantly higher in the PR group (42.9% vs 16.3%, P = .035), but there was no significant between-group difference in urethral stenosis length, operative time, operative blood loss, or the percentage of patients requiring inferior pubectomy or urethral rerouting.ConclusionPR does not facilitate delayed urethroplasty, and patients who undergo PR are at high risk of having a more complicated stenosis and longer time to urethroplasty, presumably because of repeated transurethral procedures.Copyright © 2017 Elsevier Inc. All rights reserved.

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