Patient Characteristics and Outcomes of Urethral Ligation: A TURNS Study

To characterize patient selection and midterm outcomes after urethral ligation (UL) for end-stage outlet pathology across multiple reconstructive centers.

We retrospectively identified men undergoing UL at seven Trauma and Urologic Reconstructive Network of Surgeons centers from May 2005 through June 2025. The primary outcome was recurrent incontinence. Secondary outcomes included revision, 30-day readmission, urinary tract infection (UTI), urethral fistula, and abscess. Cumulative risks of recurrence and revision were estimated using Kaplan-Meier methods.

Twenty-seven men underwent UL at a median age of 72 years (IQR 48-81). Common indications included urethral stricture/devastated urethra (29.6%), refractory incontinence (29.6%), failed bladder neck closure (25.9%), and artificial urinary sphincter erosion (22.2%). Urinary drainage was managed with a suprapubic tube in 19 patients, a continent catheterizable channel in 7, and ileovesicostomy in 1. Median follow-up was 24 months (IQR, 4-48); 11 patients (40.7%) had less than 1 year of follow-up. Three recurrences occurred within 3 months. Recurrence probability was 11.6% (95% CI, 3.9%-32.9%) and remained unchanged through 4 years. Revision risk was 3.7% (95% CI, 0.5%-23.5%). Thirty-day readmission occurred in 5 patients (18.5%). Among 16 patients with at least 1 year of follow-up, 11 (68.8%) developed UTI, and 3 (18.8%) developed urethral fistula.

In a multi-institutional cohort, urethral ligation achieved high midterm success with low risk of revision surgery or fistulation. The burden of infection and readmission highlights the need for structured postoperative surveillance and bladder-directed interventions.