Bladder neck displacement and its relevance to difficult repair of pelvic fracture urethral injury: A retrospective study.

Objective: To determine possible factors that may increase the complexity of reconstruction of pelvic fracture urethral injury. Prediction of complex repair helps in adequate patient counseling and preparation, and possible referral to high-volume reconstructive surgeons. Methods: A series of 30 adult male patients with pelvic fracture urethral injury underwent delayed posterior urethroplasty between January 2021 and December 2023 at the Assiut University Hospital and data were collected from medical records. Retrograde urethrography with voiding cystourethrogram was done 3 months after trauma. Defect length was measured and bladder neck position was verified. Urethroplasty was done using an elaborate perineal approach with inferior wedge pubectomy done in select cases. Results: Patients' ages ranged from 19 years to 53 years (median 34 years). The overall success rate of urethroplasty was 80%. Displacement of the bladder neck from the midline was significantly associated with prolonged operative time (p=0.004) and increased blood loss (p=0.002). There were strong positive correlations between preoperative defect length and operative time (rs =0.84) as well as blood loss (rs =0.78), which were statistically significant (p=0.001). Conclusion: Lateral bladder neck displacement and longer defect length in preoperative retrograde urethrogram were significantly associated with difficult urethroplasty for pelvic fracture urethral injury.