Partial Inferior Pubectomy in the Delayed Repair of Pelvic Fracture Urethral Injury: Adopting a Bone-nibbling Technique


Ikenna Ifeanyi Nnabugwu,1,2Fredrick Obiefuna Ugwumba,1,2, Anthony Alex Ilukwe2

1. Department of Surgery, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria

2. Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, PMB 01129, Enugu, Nigeria


Correspondence to: Dr Ikenna Ifeanyi Nnabugwu; email:


Received: 08 April 2020; Revised: 10 June 2020; Accepted: 19 June 2020; Available online: 7 July 2020


Background: The use of wedge inferior pubectomy can be challenging to many urethral surgeons. Our objective was to introduce a bone-nibbling technique to accomplish a partial inferior pubectomy (PIP) in a resource-poor setting, and to report the medium- to long-term outcome of using the technique. Methods: Five patients were recruited (mean age: 38.8 years) who presented, over a 30-month period, with posterior urethral fibrosis from a pelvic fracture urethral injury (PFUI). One had failed a previous attempt at posterior urethral reconstruction elsewhere. The length of urethral defect was from 2 to 4 cm. We describe a bone-nibbling technique used to carry out PIP for the delayed repair of PFUI in these patients. The outcomes in the medium to long term of surgical procedures done with this technique are presented. Results: Immediate postoperative complications in all were essentially a Clavien–Dindo grade I. Peak flow rate assessed 12 weeks’ post operation was between 20 mL/s and 23 mL/s (mean: 21 mL/s). The longest duration of follow-up was 34 months, and all patients were voiding satisfactorily. Conclusions: A satisfactory and durable outcome can be obtained from nibbling at the bone from the inferior margin of the pubic bone to achieve PIP. This is of interest to lower urinary tract reconstructive surgeons who have concerns with chiseling-out wedge of the inferior pubis.

Keywords: Bone nibbling, Partial inferior pubectomy, PFUI, Posterior urethra, Urethral anastomosis
Ann Afr Surg. 2021; 18(2): 69–74
Conflicts of Interest: None
Funding: None
© 2021 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.


The Annals of African Surgery is the official publication of the Surgical Society of Kenya.


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