An American Association for the Surgery of Trauma (AAST) prospective multi-center research protocol: outcomes of urethral realignment versus suprapubic cystostomy after pelvic fracture urethral injury

Moses, Rachel A.; Selph, J. Patrick; Voelzke, Bryan B.; Piotrowski, Joshua; Eswara, Jairam R.; Erickson, Beth; Gupta, Shubham; Dmochowski, Roger R.; Johnsen, Niels V.; Shridharani, Anand; Blaschko, Sarah D.; Elliott, Sean P.; Schwartz, Ira M.; Harris, Catherine R.; Borawski, Kristy M.; Figler, Bradley D.; Osterberg, E. Charles; Burks, Frank; Bihrle, William; Miller, Brandi; Santucci, Richard A.; Breyer, Benjamin N.; Flynn, Brian J.; Higuchi, Ty; Kim, Fernando J.; Broghammer, Joshua A.; Presson, Angela P.; Myers, Jeremy B.

doi:10.21037/tau.2017.11.07

Cited by 18 publications

(17 citation statements)

References 27 publications

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“…Because PR is easier to carry out in patients with minor injury that might heal regardless of the selected managements, such selection bias could make it appear that the PR is more effective than it actually is. 44 The success rate of PR at a level 1 trauma center in the USA has been reported to be just 9%, which is lower than that reported previously. 8 PR is technically demanding, and the degree of urethral damage caused by PR depends on the skill of the surgeon.…”

Section: Presentation and Assessment Of Pfuismentioning

confidence: 68%

“…In contrast, the existing literature also showed several problems of PR in the acute management of PFUI. Because PR is easier to carry out in patients with minor injury that might heal regardless of the selected managements, such selection bias could make it appear that the PR is more effective than it actually is . The success rate of PR at a level 1 trauma center in the USA has been reported to be just 9%, which is lower than that reported previously .…”

Section: Acute Management Of Pfuimentioning

confidence: 97%

“…As just described, acute management of PFUI remains a controversial issue mainly due to the lack of high‐quality evidence. A prospective multicenter cohort trial by the American Association for Surgery of Trauma is designed to compare outcomes between PR and SPT placement, which will clarify this issue . Because PFUI is associated with urethral stenosis at a high rate within a year whether initially managed by either PR or SPT placement, it is necessary to monitor the patients closely for at least 1 year after injury (Fig.…”

Section: Acute Management Of Pfuimentioning

confidence: 99%

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Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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Pelvic fractures from high‐energy blunt force trauma can cause injury to the posterior urethra, known as pelvic fracture urethral injury, which is most commonly associated with unstable pelvic fractures. Pelvic fracture urethral injury should be suspected if a patient with pelvic trauma has blood at the meatus and/or difficulty voiding, and retrograde urethrography should be carried out if the patient is stable. Once urethral injury is confirmed, urinary drainage should be established promptly by placement of a suprapubic tube or primary realignment of the urethra over a urethral catheter. Although pelvic fracture urethral injury is accompanied by subsequent urethral stenosis in a high rate and it has been believed that primary realignment can reduce the risk of developing urethra stenosis, it also has a risk of complicating stenosis and its clinical significance remains controversial. Once inflammation and fibrosis have stabilized (generally at least 3 months after the trauma), the optimal management for the resulting urethral stenosis is delayed urethroplasty. Delayed urethroplasty can be carried out via a perineal approach using four ancillary techniques in steps (bulbar urethral mobilization, corporal separation, inferior pubectomy and urethral rerouting). Although pelvic trauma can impair continence mechanisms, the continence after repair of pelvic fracture urethral injury is reportedly adequate. Because erectile dysfunction is frequently encountered after pelvic fracture urethral injury and most patients are young with a significant life expectancy, its appropriate management can greatly improve quality of life. In the present article, the key factors in the management of pelvic fracture urethral injury are reviewed and current topics are summarized.

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Section: Presentation and Assessment Of Pfuismentioning

confidence: 68%

Section: Acute Management Of Pfuimentioning

confidence: 97%

Section: Acute Management Of Pfuimentioning

confidence: 99%

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Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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“…Arterial repair should be attempted in cases of patients with only one kidney or in those with bilateral renal injuries. Urine extravasation is not by itself an indication for OM in the acute setting [18, 169, 180].…”

Section: Methodsmentioning

confidence: 99%

Kidney and uro-trauma: WSES-AAST guidelines

et al. 2019

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Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians.

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“…However, long-term follow-up of realigned patients has found a stenosis-free survival rates as low as 9%, as well as raised concerns regarding delays in definitive treatment [12][13][14]. A prospective, multiinstitutional trial is currently underway to provide a better assessment of the outcomes and impact of urethral realignment as compared to SPT for PFUI patients [15]. The impact of pelvic vascular injury management has not been well evaluated prior to the current study.…”

Section: Acute Managementmentioning

confidence: 98%

Multicenter analysis of posterior urethroplasty complexity and outcomes following pelvic fracture urethral injury

et al. 2019

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Purpose To analyze outcomes of posterior urethroplasty following pelvic fracture urethral injuries (PFUI) and to determine risk factors for surgical complexity and success. Methods Patients who underwent posterior urethroplasty following PFUI were identified in the Trauma and Urologic Reconstructive Network of Surgeons (TURNS) database. Demographics, injury patterns, management strategies, and prior interventions were evaluated. Risk factors for surgical failure and the impact of ancillary urethral lengthening maneuvers (corporal splitting, pubectomy and supracrural rerouting) were evaluated. Results Of the 436 posterior urethroplasties identified, 122 were following PFUI. 83 (68%) patients were acutely managed with suprapubic tubes, while 39 (32%) underwent early endoscopic realignment. 16 (13%) patients underwent pelvic artery embolization in the acute setting. 116 cases (95%) were completed via a perineal approach, while 6 (5%) were performed via an abdominoperineal approach. The need for one or more ancillary maneuvers to gain urethral length occurred in 4 (36%) patients. Of these, 44 (36%) received corporal splitting, 16 (13%) partial or complete pubectomy, and 2 (2%) supracrural rerouting. Younger patients, those with longer distraction defects, and those with a history of angioembolization were more likely to require ancillary maneuvers. 111 patients (91%) did not require repeat intervention during follow-up. Angioembolization (p = 0.03) and longer distraction defects (p = 0.01) were associated with failure. Conclusions Posterior urethroplasty provides excellent success rates for patients following PFUI. Pelvic angioembolization and increased defect length are associated with increased surgical complexity and risk of failure. Surgeons should be prepared to implement ancillary maneuvers when indicated to achieve a tension-free anastomosis.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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An American Association for the Surgery of Trauma (AAST) prospective multi-center research protocol: outcomes of urethral realignment versus suprapubic cystostomy after pelvic fracture urethral injury

Cited by 18 publications

References 27 publications

Management of male pelvic fracture urethral injuries: Review and current topics

Management of male pelvic fracture urethral injuries: Review and current topics

Kidney and uro-trauma: WSES-AAST guidelines

Multicenter analysis of posterior urethroplasty complexity and outcomes following pelvic fracture urethral injury

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