Introduction: Pelvic fracture urethral injury (PFUI) often results from significant, high-energy trauma such as motor vehicle accidents (MVAs) or crush injuries. PFUI doesn’t spare those in third-world countries who may not have access to reliable healthcare. We aim to compare outcomes of PFUI repair in the US and third-world countries.
Methods: A retrospective chart review and comparative analysis were performed on patients who had a PFUI repair during international trips to Haiti and Rwanda and a cohort of US patients from 2014-2020. FB performed all US repairs while FB and DR collaborated internationally with local urologists.
Results: A total of 43 patients met inclusion criteria and were included in the analysis: 29 international patients and 14 US patients. Mean age of the US cohort was 38.8 years (range 22-62) versus 35.9 years (range 17-65) in the international cohort (p=0.43). The etiology of the injury was similar between both groups with MVA being the most common cause for both (52% in the international group versus 57% in the US group), followed by crush injury (28% versus 21%), and finally pedestrian versus automobile (17% versus 21%). Mean urethral distraction length was also similar between the two groups (US=2.2 cm, international=3.2 cm, p= 0.12). There was a trend toward significance in mean operative time with longer times in the US group (207.5 min vs 179.7 min, p=0.06), although this difference no longer existed when controlling for two US patients who had their repair as part of a joint procedure with orthopedic surgery (p=0.35). There was no difference in estimated blood loss between the US and international cohorts (228.6 mL vs. 203.6 mL, p=0.43).
Conclusions: Our study indicates that PFUI repair, even when performed in third-world countries like Haiti and Rwanda, can be performed with similar results compared to operating in the US. These results highlight the feasibility of safely performing complex procedures in poor and underserved areas and will hopefully encourage others to donate their knowledge and skillsets to provide care to those with limited access to adequate healthcare.
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