Outcomes of bulbar artery sparing during anastomotic urethroplasty for pelvic fracture urethral injury

Objective: To the present long-term outcomes of the vascular-sparing approach during reconstruction of pelvic fracture urethral injuries (PFUI) described by Gomez et al. MATERIAL AND METHODS: Anastomotic reconstruction of PFUI is performed without transecting the bulb of the spongiosum, to preserve the antegrade flow of the bulbar arteries. After exposure of the urethra, the bulbar arteries are located using a Doppler stethoscope. The bulb is mobilized dorsally and unilaterally, sacrificing the artery with the weaker Doppler signal to preserve the best contralateral artery. Occasionally, both arteries can be preserved. Removal of all fibrosis and anastomosis is performed as described in the traditional transecting technique.

Results: A total of 60 patients were included, with a mean age of 37 years (IQR 22-48). The median time from trauma to urethral reconstruction was 16 weeks, and the mean stenosis length was 2.5 cm (IQR 2-3). The left bulbar artery was preserved in 27 cases, the right bulbar artery in 8, and both in 24. There were postoperative complications in 14 cases (23%), but only one of them was Clavien ≥ III. With a mean follow-up of 56 months (IQR 12-87), only one patient failed due to stenosis (98% success).

Conclusion: Preservation of antegrade arterial flow to the corpus spongiosum during PFUI reconstruction is feasible and safe. Although slightly more elaborate, this technique could reduce the risk of ischemic failure of reconstruction.