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Perineal posterior urethroplasty via excision and primary anastomosis (EPA) is the standard treatment. This study evaluates risk factors for stenosis recurrence after primary EPA and analyzes predictors of postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on male patients who underwent primary posterior EPA for PFUI at Ghent University Hospital (2001\u20132024). The primary outcome was stenosis recurrence at 1-, 2-, and 10-year follow-up, defined as urethral narrowing causing obstructive symptoms and requiring intervention. Demographic data, prior urethral manipulation, surgical techniques, 90-day complications (Clavien-Dindo), and functional outcomes were analyzed. Univariate and multivariate coxregression analyses were performed using IBM SPSS Statistics v. 29.0.2.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 70 patients, 75.5% underwent transecting EPA. After a median follow-up of 130 months (IQR 78.5-178.5), stenosis recurrence occurred in 15.8% at a median of 3 months (IQR 2.0\u20135.0). The 1-, 2-, and 10-year recurrence-free survival rates were 85.4%, 83.8%, and 83.8%, respectively. In multivariate analysis, postoperative complications (HR\u2009=\u20094.85,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007) and persistent extravasation (HR\u2009=\u20096.36,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) significantly increased recurrence risk. Postoperative complications (21.4%) were all low-grade and managed conservatively. Erectile function was impaired in 97.9% due to trauma, with 12.2% improving postoperatively. De novo urinary incontinence occurred in 6.6%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Posterior urethroplasty demonstrates a high long-term success rate in patients with PFUI. Postoperative complications and persistent urinary leakage significantly increase the risk of surgical failure, highlighting the need for rigorous follow-up. The non-transecting technique, when possible, does not negatively impact outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00345-025-05839-3","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T14:00:00Z","timestamp":1754056800000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Posterior urethroplasty for pelvic fracture urethral injuries: risk factors for recurrence and complications"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8781-1216","authenticated-orcid":false,"given":"Natalia","family":"Plamadeala","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1642-7263","authenticated-orcid":false,"given":"Marjan","family":"Waterloos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9510-611X","authenticated-orcid":false,"given":"Mieke","family":"Waterschoot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1242-3644","authenticated-orcid":false,"given":"Nicolaas","family":"Lumen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"5839_CR1","doi-asserted-by":"publisher","first-page":"S29","DOI":"10.21037\/tau.2017.12.35","volume":"7","author":"RC Barratt","year":"2018","unstructured":"Barratt RC, Bernard J, Mundy AR, Greenwell TJ (2018) Pelvic fracture urethral injury in males\u2014mechanisms of injury, management options and outcomes. 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