title: The spectrum of pelvic fracture urethral injuries and posterior urethroplasty in an Italian high-volume centre, from 1980 to 2013.
abstract: OBJECTIVE
  To describe the emergency and delayed treatment of patients with pelvic fracture urethral injuries (PFUI) presenting to an Italian high-volume centre.
  
  
  METHODS
  In a retrospective, observational study we evaluated the spectrum of PFUI and posterior urethroplasty in an Italian high-volume centre, from 1980 to 2013. Patients requiring emergency treatment for PFUI and delayed treatment for pelvic fracture urethral defects (PFUD) were included. Patients with incomplete clinical records were excluded from the study. Descriptive statistical methods were applied.
  
  
  RESULTS
  In all, 159 male patients (median age 35 years) were included in the study. A traffic accident was the most frequent (42.8%) cause of PFUI, and accidents at work were reported as the cause of trauma in 34% of patients. Agricultural accidents decreased from 24.4% to 6.2% over the course of the survey. A suprapubic cystostomy was the most frequent (49%) emergency treatment in patients with PFUI. The use of surgical realignment decreased from 31.7% to 6.2%, and endoscopic realignment increased from 9.7% to 35.3%. A bulbo-prostatic anastomosis was the most frequent (62.9%) delayed treatment in patients with PFUD. The use of the Badenoch pull-through decreased from 19.5% to 2.6%, and endoscopic holmium laser urethrotomy increased from 4.9% to 32.7%.
  
  
  CONCLUSIONS
  The spectrum of PFUI and subsequent treatment of PFUD has changed greatly over the last 10 years at our centre. These changes involved patient age, aetiology, emergency and delayed treatments, and were found to be related to changes in the economy and lifestyle of the Italian patients.
authors.affiliation: Center for Reconstructive Urethral Surgery, Centro Chirurgico Toscano, Arezzo, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Barbagli
authors.affiliation: Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sansalone
authors.affiliation: Unit of Urology, Ospedale San Donato, ASL 8, Arezzo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Romano
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
keywords: ER, endoscopic realignment; HLU, holmium laser urethrotomy; PFUD, pelvic fracture urethral defects; PFUI, pelvic fracture urethral injuries; PR, primary urethral realignment; PU, posterior urethroplasty; SPC, suprapubic cystostomy; SR, surgical realignment; Stricture; Trauma; Treatment; Urethra