Uroflowmetry or Urethroscopy as a Surveillance Tool After End-to-End Anastomotic Urethroplasty Done for PFUI—A Blinded Study

Background/Objectives: Uroflowmetry is done in the surveillance period after End-to-end Anastomotic Urethroplasty for pelvic fracture urethral injury. But is maximum flow rate a reliable surrogate for urethral calibre in these cases? The above question laid the foundation of the study. The aim of the study was: “Is uroflowmetry alone sufficient to predict a successful outcome following urethroplasty after pelvic fracture urethral injury (PFUI)?” Methods: We conducted a prospective masked study of all patients undergoing end-to-end anastomosis (EEA) urethroplasty for PFUI from January 2017 to September 2022. The first follow-up was 4 weeks after surgery, micturating cystourethrogram (MCU) was done after urethral catheter removal and at the same time, uroflowmetry was also done. The second follow-up was 6 months after surgery, when uroflowmetry was repeated, and urethroscopy was performed. The urologist performing urethroscopy was blinded to the uroflowmetry results. Results: In total, 26 patients were included in the study. After 6 months, 1 patient had poor flow (maximum flow rate [Q max] < 10 mL/s), 7 patients had flow with Q max 10–15 mL/s, and 18 patients had normal flow (Q max > 15 mL/s). On urethroscopy, all patients had a normal and easily passable urethra. The International Prostate Symptom Score (IPSS) and quality of life (QoL) scores showed a positive correlation. The urologist performing urethroscopy and the investigator recording uroflowmetry reached different conclusions. Conclusions: A reduced peak on uroflowmetry after EEA urethroplasty in PFUI does not always indicate surgical failure. Urethroscopy enables direct visualisation of the anastomotic site and provides more detailed information than uroflowmetry. The IPSS score and quality of life are more important than Q max alone.