Introduction: Internal urethrotomy (IU) in patients with urethral contracture following perineal repair of
pelvic fracture urethral injuries (PRPFUI) is troublesome. We evaluated the clinical factors affecting the
surgical outcome of IU for urethral contracture after PRPFUI.
Materials and methods: We retrospectively reviewed the records of 35 patients who underwent IU for
urethral contracture after PRPFUI between March 2004 and June 2013. Ages of patients ranged from 18 to
50, and their follow-up duration was more than 1 year after IU. The urethral contracture was confirmed
by retrograde urethrogram or cysto-urethroscopy. Success was defined as greater than 15 mL/s of peak
urinary
flow rate at 1 year after IU without any clinical evidence of urethral contracture. Success rates
were investigated according to the number of IU. Age, body mass index, urethral defect length before
PRPFUI, time interval between the original urethral injury and the PRPFUI or between a previous
operation and the PRPFUI, time interval between the PRPFUI and the urethral contracture, number of
PRPFUI performed, and the type of urethral lengthening procedure were compared between patients
with and without success according to the number of IU.
Results: Among the 35 patients, the overall success rate of IU was 37% (13/35) during the mean follow-up
period of 53 months (range: 17–148 months). There were 8 and 5 patients with success in
first and second
IU, respectively. However, there was no success after third IU. Urethral defect length before PRPFUI was
significantly shorter in patients with success who underwent
first and second IU (p < 0.05). There were
significant differences of success between patients with and without previous repeated failures of PRPFUI
in
first and second IU (p < 0.05).
Conclusions: Short urethral defect length and no previous surgical failures before PRPFUI are good
prognostic factors for IU following PRPFUI. Only one or two IUs will be helpful in patients with urethral
contracture following PRPFUI