Published: 2020-06-26

Prospective randomised study of cases of pelvic fracture urethral distraction defects managed by early alignment versus initial suprapubic urinary diversion with delayed urethroplasty

Arun Kumar, Gunjeet Kaur, Krishna Kant Singh, H. S. Pahwa, Awanish Kumar, Dhirendra Pratap, Priyanka Agrawal


Background: In complex pelvic fracture urethral distraction defects (PFUDD), early management prevents incidence of devastating complications such as urinary incontinence, restenosis and urethra cutaneous fistula. The aim of the present study was to study the outcome of patients with PFUDD undergoing early alignment (either by rail roading or endoscopic) compared with initial suprapubic urinary diversion with delayed urethroplasty.

Methods: This was a prospective randomized study done at KGMU, Lucknow; having PFUDD during the period from June 2014 to July 2017. Patients with PFUDD were randomized in to two groups. Group A included 22 patients and managed by supra pubic cystostomy followed by delayed urethroplasty. Group B included 23 patients and managed by primary alignment by rail-roading and early endoscopic alignment. Patients were followed up after 6 weeks, 3 months and 6 months for measuring the primary and secondary outcomes during follow up.

Results: The most common age group that sustained pelvic fracture urethral distraction defects injury are male of 21-40 years. In group A, stricture was present in all patients at 6 weeks post-surgery. Open urethroplasty was done at 3 months in 60% and 10% patients at 6 months.  In group B, stricture was present in 80% at 6 weeks, 40% at 3 months and 10% at 6 months. The incidence of ED in group A at 6 weeks, 3 months, was 25% patient which reduced to 20% at 6 months. In group B, ED was present in 30% patients 6 weeks, 3 months and which reduced to 25% at 6 months. No incontinence was observed in both groups.

Conclusions: Primary realignment has significant benefits compared to SPC as realignment approach is associated with a 50%-55% decrease in stricture formation.


Open urethroplasty, Pelvic fracture urethral distraction defects, Primary realingnment

Full Text:



Koraitim MM, Marzouk ME, Atta MA, Orabi SS. Risk factors and mechanism of urethral injury in pelvic fractures. Br J Urol. 1996;77(6):876-80.

Ríos E, Martínez-Piñeiro L. Treatment of posterior urethral distractions defects following pelvic fracture. Asian J Urol. 2018;5(3):164-71.

Mundy AR, Andrich DE. Pelvic fracture-related injuries of the bladder neck and prostate: Their nature, cause and management. BJU Int. 2010;105:1302-8.

Barrett K, Braga LH, Farrokhyar F, Davies TO. Primary realignment vs suprapubic cystostomy for the management of pelvic fracture-associated urethral injuries: A systematic review and meta-analysis. Urology. 2014;83:924-9.

Kulkarni SB, Joshi PM, Hunter C, Surana S, Shahrour W, Alhajeri F, et al. Complex posterior urethral injury. Arab J Urol. 2015;13:43-52.

Fu Q, Zhang J, Sa YL, Jin SB, Xu YM. Recurrence and complications after trans perineal bulboprostatic anastomosis for posterior urethral strictures resulting from pelvic fracture: A retrospective study from a urethral referral center. BJU Int. 2013;112:358-63.

Eustace D, Wei H. The Role of Driver Age and Gender in Motor Vehicle Fatal Crashes. J Transportation Safety Journey. 2010;2(1):28-44.

Gulliver P, Begg D. Personality factors as predictors of persistent risky driving behavior and crash involvement among young adults. Injury Prevention. 2007;13:376-81.

Jenkins EL, Kisner SM, Forsbroke DE, Layne LA, Stout NA, Castillo DN, et al. Fatal injuries to workers in United States, 1980-1990: A decade of surveillance; national profile 2007;13:376-81.

Dandan IS, Farhat W. Trauma, Lower genitourinary. Available at: Accessed on 10 January 2019.

Sherry E. World Ortho Textbook of Orthopaedics. Trauma and Sports Medicine. Chapter 28. 2010.

Cass AS, Godec CJ. Urethral injury due to external trauma. Urology. 1978;11:607-11.

Elliott DS, Barrett DM. Long-term follow-up and evaluation of primary realignment of posterior urethral disruptions. J Urol. 1997;157:814.

Asci R, Sarikaya S, Büyükalpelli R, Saylik A, Yilmaz AF, Yildiz S. Voiding and sexual dysfunctions after pelvic fracture urethral injuries treated with either initial cystostomy and delayed urethroplasty or immediate primary urethral realignment. Scand J Urol Nephrol. 1999;33:228-33.

Koraitim MM. The lessons of 145 posttraumatic posterior urethral strictures treated in 17 years. J Urol. 1995;153:63-6.

Turner-Warwick R. Prevention of complications resulting from pelvic fracture urethral injuries-and from their surgical management. Urol Clin North Am. 1989;16:335-58.

Matthews LA, Herbener TE, Seftel AD. Impotence associated with blunt pelvic and perineal trauma: penile revascularization as a treatment option. Semin Urol. 1995;13:66-72.

Armenakas NA, McAninch JW, Lue TF, Dixon CM, Hricak H. Posttraumatic impotence: magnetic resonance imaging and duplex ultrasound in diagnosis and management. J. Urol. 1993;149(5):1272-5.