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Single-surgeon series of delayed anastomotic urethroplasty for pelvic fracture urethral injury: an analysis of surgical and patient-reported outcomes of a 10-year experience in a Japanese referral center

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Abstract

Purpose

To report our experience with delayed anastomotic urethroplasty for pelvic fracture urethral injury (PFUI) during the last 10 years and evaluate both surgical and patient-reported outcomes.

Methods

Retrospective analysis of 115 patients undergoing delayed anastomotic urethroplasty for PFUI between 2008 and 2017 by a single surgeon (AH) was performed. Success was defined as a urethral lumen large enough for passage of a 17-Fr flexible cystoscope. We asked patients to complete questionnaires before (baseline) and 1 year after urethroplasty and compared by paired t and Wilcoxon signed-rank tests the answers to a question about LUTS-specific QOL and the health-related QOL indicated by EQ-5D index and visual analogue scores (EQVAS). Overall patient satisfaction 1 year after urethroplasty was also evaluated.

Results

Urethroplasty was successful in 108 patients (93.9%), and failed urethroplasty was significantly associated with greater intraoperative blood loss (p = 0.009) and smaller surgical experience (p = 0.018). Sixty-six patients (57.4%) completed questionnaires 1 year after urethroplasty, and 65 of those 66 (98.5%) were “satisfied” (36.4%) or “very satisfied” (62.1%) with the outcome of their urethroplasty. The LUTS-specific QOL scores (p < 0.0001), EQ-5D index scores (p < 0.0001), and EQVAS scores (p < 0.0001) all improved significantly after urethroplasty.

Conclusions

Delayed anastomotic urethroplasty has a high success rate and significant beneficial effects on both LUTS-specific and health-related QOL, resulting in high patient satisfaction. Careful manipulation in a bloodless operative field by experienced surgeons could be the key to successful urethroplasty.

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Acknowledgements

This study was supported by a grant for scientific research from the Ministry of Education, Science, Sports and Culture (16H05467). We have no financial interests to disclose.

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Authors and Affiliations

  1. Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Akio Horiguchi, Masayuki Shinchi, Kenichiro Ojima, Ayako Masunaga, Keiichi Ito & Tomohiko Asano

  2. Department of Urology, Nishisaitama-chuo National Hospital, Saitama, Japan

    Eiji Takahashi & Fumihiro Kimura

  3. Department of Plastic Surgery, National Defense Medical College, Saitama, Japan

    Ryuichi Azuma

Authors
  1. Akio Horiguchi
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  2. Masayuki Shinchi
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  3. Kenichiro Ojima
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  4. Ayako Masunaga
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  5. Keiichi Ito
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  6. Tomohiko Asano
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  7. Eiji Takahashi
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  8. Fumihiro Kimura
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  9. Ryuichi Azuma
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Contributions

AH: data collection, project development, data analysis, and manuscript writing. MS: data collection/analysis. KO: data collection. AM: data collection. KI: data collection. TA: data collection. ET: data collection. FK: data collection. RA: data collection, project development, and manuscript editing.

Corresponding author

Correspondence to Akio Horiguchi.

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Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Horiguchi, A., Shinchi, M., Ojima, K. et al. Single-surgeon series of delayed anastomotic urethroplasty for pelvic fracture urethral injury: an analysis of surgical and patient-reported outcomes of a 10-year experience in a Japanese referral center. World J Urol 37, 655–660 (2019). https://doi.org/10.1007/s00345-019-02630-z

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  • DOI: https://doi.org/10.1007/s00345-019-02630-z

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