Preliminary Evaluation of Nontransecting Anastomotic Urethroplasty for Pelvic Fracture Urethral Injury: Insights From a Comparison With Excision and Primary Anastomosis.

Objectives: To evaluate the feasibility and surgical and patient-reported outcomes of nontransecting anastomotic urethroplasty (NTAU) for male patients with pelvic fracture urethral injury (PFUI) compared with excision and primary anastomosis (EPA), the current mainstay surgical approach.

Methods: This retrospective study analyzed 233 male PFUI patients treated with EPA (n = 223) or NTAU (n = 10) from 2008 to 2024 by a single surgeon (AH). NTAU involves preserving urethral continuity and maintaining bilateral bulbar artery integrity while excising scar tissue and achieving tension-free urethral anastomosis. Anatomical success was defined as the ability to pass a 17Fr flexible cystourethroscope through the anastomotic site without resistance and no need for additional treatments. Postoperative functional outcomes were assessed using validated patient-reported measures, including the LUTS-specific quality-of-life (QOL) questionnaire, the Sexual Health Inventory for Men (SHIM), and the EuroQol Visual Analog Scale (EQ-VAS).

Results: Although the median follow-up period was significantly shorter for NTAU (12 vs. 69 months, p < 0.0001), the anatomical success rate was 100% for NTAU and 94.6% for EPA, with no significant difference between the groups (p = 0.45). No significant differences were observed in the perioperative complication rate (p = 0.54). The changes in LUTS-QOL, SHIM, and EQ-VAS scores from preoperative to postoperative assessments were also comparable, indicating similar patient-reported outcome improvements in both groups (p = 0.71, p = 0.16, p = 0.92, respectively).

Conclusion: NTAU has the potential to achieve surgical and patient-reported outcomes comparable to EPA. Further studies are warranted to validate its long-term benefits and define its optimal indications.