Elaborated perineal urethroplasty with tension and fibrosis free anastomosis is the gold standard surgical treatment for pelvic fracture urethral injury (PFUI). Prostato-urethral gap distance and displacement direction have an impact on choosing surgical technique and outcome. Our objective is to imply both gapometry and displacement direction as predictors for early surgical outcome of PFUI repair.

Twenty patients (≥18 years) with PFUI underwent elaborated perineal urethroplasty. Gapometry and displacement direction were measured intraoperatively by combined urethroscopy and suprapubic cystoscopy under real time fluoroscopy at 45° and 60° with combined cysto-urethrogram. Follow up occurred at 1, 3 and 6 months postoperatively for assessment of outcomes (international prostate symptom score (IPSS), urethral stricture surgery patient-reported outcome measures (USS PROM),maximum urine flow rate (Q-max), post voiding residual urine (PVR) & perioperative complications). Success was defined as a normal voiding without straining, with Q-max ≥ 15 ml/s, no need for dilatation, no evidence of stricture and no re-intervention.

The mean age was 34.6 ± 12.12 years. 13 patients (65%) had anterior displacement, 4 patients (20%) had posterior displacement and 3 patients (15%) with no displacement in 60° plane at fluoroscopy. The mean gap length was 49 ± 9.75 millimeter [(52.38 ± 10.7) in anterior displacement, (48.25 ± 8.05) in posterior displacement and (44.5 ± 2.12) with no displacement]. Mean operative time (OR time) was 165.6 ± 32.25 min [(172.23 ± 27.79) in anterior displacement, (148.75 ± 23.93) in posterior displacement and (138.33 ± 23.09) in cases with no displacement]. Failure rate with anterior displacement was (7.69%) and (23.07%) at 3 and 6 month respectively. Overall osteotomy rate was 45% (61.5% and 25% in anterior and posterior displacement respectively). Blood transfusion was needed in 3 cases only with anterior displacement. Postoperative Q-max was 16.66 ± 2.49 ml/s and 14.66 ± 3.87 ml/s at 3 and 6 months respectively.

Success rate was 100 % in cases with posterior and no displacement. Failure was in 1 case of the 13 cases with anterior displacement (7.69%) after 3 month and 3 cases (23.07%) after 6 months who needed re-intervention.

Surgical repair of PFUI is affected not only by the prostato-urethral gap distance but also the direction of displacement. Patients with anterior displacement had longer OR time, higher transfusion and failure rates compared to patient with posterior or no displacement.