Early versus delayed urethroplasty for pediatric pelvic fracture-related urethral injury in boys: a retrospective comparative cohort study of complications and surgical success rates from a single center.

Background: The optimal timing of urethroplasty for pediatric pelvic fracture-associated urethral injury (PFUI) in boys remains controversial, with limited long-term data. This study aimed to compare the complications and surgical success rates between early (≤10 days) and delayed (≥3 months) urethroplasty in a long-term pediatric cohort. Methods: This retrospective study included boys who underwent PFUI urethroplasty at a single center (2001-2023). Exclusion criteria included loss to follow-up, death, and prior realignment or urethral surgery elsewhere. Early repair was defined as ≤10 days post-injury, and delayed repair as ≥3 months. Outcomes included stricture (clinical or cystoscopic), incontinence (any leakage), erectile dysfunction (ED, by parental or self-report), and reoperation. Statistical comparisons used Mann-Whitney U and Fisher's exact tests. Results: Among 100 screened patients, 48 were analyzed (median follow-up 112 months): 15 in the early group and 33 in the delayed group. Surgical timing was determined by referral time rather than clinical severity; however, the two groups differed in post-injury management patterns, which may introduce selection bias. The overall complication rate was 54.2% (26/48): stricture 41.7% (20/48), incontinence 22.0% (9/41), ED 29.3% (12/41), and reoperation 37.5% (18/48). No significant differences were observed between early and delayed groups for stricture (5/15 Conclusions: This single-center study does not provide conclusive evidence for superiority of either early or delayed urethroplasty in boys with PFUI. Potential clinically important differences cannot be ruled out. Larger multicenter studies are needed.