Posterior Bulboprostatic Excision and Primary Anastomosis for Pelvic Fracture Urethral Injury: Long-term Objective and Patient-reported Outcomes

PURPOSE: Posterior bulboprostatic excision and primary anastomosis (EPA) is considered standard of care for obliterative or disruptive pelvic fracture urethral injuries (PFUIs), yet validated patient-reported outcomes (PROMs) in this setting remain limited. We aimed to evaluate long-term reintervention-free survival (RFS) and PROMs following EPA. PATIENTS AND METHODS: This retrospective study included male patients undergoing transperineal bulboprostatic EPA for PFUI between 2014 and 2024 at a tertiary reconstructive referral center. Data collected included trauma etiology, comorbidities, prior interventions, operative details, and follow-up duration. Co-primary endpoints were RFS estimated by Kaplan-Meier analysis, and PROMs assessed using validated instruments. RESULTS: Seventy patients (median age 48 years) underwent EPA. Initial management included suprapubic catheter (77%), endoscopic (21%), or open realignment (1.4%). Median operative time was 77 minutes; median follow-up was 53 months. RFS was 87% at 2 years and 84% at 5 years. PROMs-available in 53% of patients at median 71 months-included moderate voiding/incontinence symptoms (median LUTS score 6; ICIQ-UI SF 7), severe erectile dysfunction (IIEF-EF 7), preserved ejaculatory function (MSHQ-Ej 24), high satisfaction (ICIQ-S 21; global satisfaction 9), and negligible decision regret (median 0). Limitations include retrospective design and incomplete PROM data (53% response rate). CONCLUSIONS: Bulboprostatic EPA offers durable anatomical success and high long-term patient satisfaction despite persistent functional impairments largely linked to initial trauma. Most patients expressed minimal regret and willingness to repeat the procedure. These outcomes reinforce EPA's role as the standard of care in PFUI management.