Comparative Study of the Efficacy and Complications of Urethral Realignment and Primary Urethral Anastomosis for Traumatic Urethral Injuries in Emergency Surgical Management

<p style="text-align:justify;"> Objective: Traumatic urethral injuries (TUI) represent a critical urological emergency. This study aims to compare the efficacy and complications of urethral realignment and primary urethral anastomosis in the management of TUI. <p style="text-align:justify;"> Methods: A retrospective analysis was conducted on patients treated at Fuyang People’s Hospital between January 2022 and December 2024. The patients were categorised into urethral realignment and primary anastomosis groups according to the surgical procedure performed. Outcomes assessed included operative time, blood loss, hospital stay, catheterisation duration, pain (Visual Analogue Scale), inflammatory markers (C-reactive protein, interleukin-6 and tumour necrosis factor-α), functional parameters (maximum urinary flow rate, Qmax; post-void residual volume; International Index of Erectile Function-5, IIEF-5) after 3 months of follow-up and postoperative complications within 6 months. <p style="text-align:justify;"> Results: Among 129 eligible patients, 71 underwent urethral realignment and 58 underwent primary urethral anastomosis. The realignment group had a shorter average operative time (98.43 ± 23.67 vs. 143.27 ± 31.85 min, p < 0.001), less blood loss (87.62 ± 28.41 vs. 152.89 ± 45.73 mL, p < 0.001), lower pain scores (3.62 ± 0.89 vs. 4.28 ± 1.13, p < 0.001) and reduced inflammatory markers (all p < 0.01). The anastomosis group showed better urinary flow (Qmax: 22.47 ± 3.88 vs. 18.93 ± 4.26 mL/s, p < 0.001), lower residual volume (18.59 ± 9.46 vs. 26.84 ± 12.73 mL, p < 0.001), higher IIEF-5 scores (19.42 ± 2.39 vs. 18.27 ± 2.23, p = 0.006) and a lower stricture rate (5.17% vs. 18.31%, p = 0.024). <div style="text-align:justify;"> Conclusions: Urethral realignment offers advantages in operative efficiency and early postoperative recovery parameters (pain, inflammation), whereas primary urethral anastomosis provides superior long-term functional outcomes with a lower risk of </div> <div style="text-align:justify;"> stricture and a shorter catheterisation period. </div>