Pelvic Fracture and Fall Astride Urethroplasty is a reconstructive procedure performed to repair urethral disruption or obliteration resulting from pelvic trauma, including high-impact pelvic fracture injuries and fall astride mechanisms. These injuries commonly occur due to motor vehicle accidents, crush injuries, or blunt perineal trauma from falling astride objects, and often result in complete urethral separation. Initial management typically involves suprapubic catheter diversion, with delayed reconstruction once pelvic stability is restored.
Due to significant scarring, anatomical distortion, and the proximity of the injury to the urinary sphincter and rectum, this form of urethroplasty is highly complex and requires advanced surgical expertise. Patients are generally advised to wait 3–6 months post-injury to allow for healing, inflammation resolution, and optimal surgical planning.
This procedure requires proficiency in both perineal and abdomino-perineal approaches, management of long-gap posterior urethral defects, and preservation of urinary continence and erectile function. It is considered one of the most technically demanding forms of urethral reconstruction.
Post-operative care includes a structured recovery protocol. The urethral catheter is removed after a peri-catheter urethrogram confirms satisfactory healing at 2 weeks, and the suprapubic catheter is removed at 3 weeks. Surgical success is assessed at 3 months with a follow-up urethrogram.
