Old discussion, the same challenge: revisiting radiological predictors for urethroplasty complexity in male...

Several radiological predictors of pelvic fracture urethral injuries (PFUI) repair complexity have been proposed, but they have not been compared in external cohorts or tested against each other. This study evaluates the reliability and accuracy of indicators from Koraitim et al. and Yepes et al. in predicting surgical complexity in adult men with PFUI.

Retrospective review of adult men who underwent PFUI repair between January 2011 and February 2024 in our center. Preoperative urethrocystographies (UCG) were analyzed for urethral gap length and gapometry index (Koraitim), and for the position of the proximal urethral stump (PUS) relative to the inferior margin of the pubic symphysis (Yepes). Predictors were compared with intraoperative complexity, defined by the need for advanced maneuvers or abdomino-perineal access. Accuracy parameters were calculated for each predictor and their combination.

Of 81 patients treated in this period (median age 36 years), 55.6% (45/81) were excluded from analysis, with the absence of bladder neck opening being the most common cause (30/45). In the 36 evaluable cases, neither gapometry (p = 0.069) nor gapometry index (p = 0.158) were associated with complexity. Only PUS location above the inferior margin of the pubic symphysis was associated with it (p = 0.031). The presence of any predictor yielded 100% sensitivity and 42.3% specificity for predicting complexity. All patients without predictors underwent non-complex repairs (p = 0.071).

Radiological predictors showed limited reliability and accuracy, though PUS position correlated with complexity. The absence of radiological criteria may help identify straightforward cases.