Contemporary Review of Pelvic Fracture Urethral Injury Management and Outcomes

As a life-threatening injury, the initial management of pelvic fractures focuses on trauma resuscitation. A secondary goal is the treatment of associated injuries, such as urethral damage, to prevent late complications because urethral stenosis has been observed in >90% of the patients. Additionally, urethral injury is often linked with erectile dysfunction and urinary incontinence. When analyzing the long-term outcomes of the initial management of complete urethral injuries, no significant impact on stenosis rates or the complexity of future urethral reconstruction is observed. The best time to perform urethral reconstruction is when larger lesions, mainly orthopedic, are stabilized, and the patient can be placed in a lithotomy position, usually between 3 and 6 mo. Endoscopic procedures should be avoided in the delayed management of posttraumatic urethral stenosis, and a perineal anastomotic repair is the preferred surgical method, with a high success rate. Recently, there has been increased interest in the vascular-sparing approach to anastomotic repair, including in traumatic cases. A combined abdominoperineal approach would be necessary in cases of high complexity. As with other pelvic approaches, robotic platforms have the potential to be useful for urethral reconstruction when abdominal access is needed.