Outcomes Following Primary Realignment Versus Suprapubic Cystostomy with Delayed Urethroplasty for Pelvic Fracture-Associated Posterior Urethral Injury: A Systematic Review with Meta-Analysis

Light, Alexander; Gupta, Tanya; Dadabhoy, Maria; Daniel, Allen; Nandakumar, Madura; Burrows, Abigail; Karthikeyan, Sandeep

doi:10.1159/000499282

Cited by 16 publications

(13 citation statements)

References 31 publications

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“…Anastomotic urethroplasty remains the gold standard for the treatment of pelvic fractures urethral injuries (PFUI) and the aim of this surgery is to allow a tension free bulbomembranous anastomosis [51]. In seven studies for a total of 227 patients, an urological treatment was performed.…”

Section: Treatment and Complications Of Pelvic Ring Injuriesmentioning

confidence: 99%

Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

Rovere

Perna

Meccariello³

et al. 2021

International Orthopaedics (SICOT)

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Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.

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Section: Treatment and Complications Of Pelvic Ring Injuriesmentioning

confidence: 99%

Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

Rovere

Perna

Meccariello³

et al. 2021

International Orthopaedics (SICOT)

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“…13 46 49 50 However, the management and the relevance of early versus delayed surgical or conservative treatment approaches after PFUI is still controversially discussed. [51][52][53][54] Excluding PFUI, this study concludes an incidence of ED based on standardised IIEF-5 questionnaires of 41.5% ranging from 29.7% to 71.4%, whereas the broad variance of incidence is mostly depending on injury severity. According to our meta-analysis, there is a visible trend for an increased rate of ED among higher classifications of PRF injuries.…”

Section: Rate Of Ed After Prfmentioning

confidence: 76%

Erectile dysfunction and penile rehabilitation after pelvic fracture: a systematic review and meta-analysis

et al. 2021

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ObjectiveTo investigate the rate of erectile dysfunction (ED) after pelvic ring fracture (PRF).DesignSystematic review and meta-analysis.MethodsA systematic literature search of the Cochrane, EMBASE, MEDLINE, Scopus and Web of Science Library databases was conducted in January 2020. Included were original studies performed on humans assessing ED after PRF according to the 5-item International Index of Erectile Function (IIEF-5) questionnaire and fracture classification following Young and Burgess, Tile or Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association. Furthermore, interventional cohort studies assessing the effect of penile rehabilitation therapy with phosphodiesterase-5-inhibitors (PDE-5-I) on IIEF-5 scores compared before and after treatment were included. Results were presented as forest plots of proportions of patients with ED after PRF or mean changes on IIEF-5 questionnaires before and after penile rehabilitation. Studies not included in the quantitative analysis were narratively summarised. Risk of bias assessment was conducted using the revised tool for the Quality Assessment on Diagnostic Accuracy Studies.ResultsThe systematic literature search retrieved 617 articles. Seven articles were included in the qualitative analysis and the meta-analysis. Pooled proportions revealed 37% of patients with ED after suffering any form of PRF (result on probability scale pr=0.37, 95% CI: 0.26 to 0.50). Patients after 3 months of penile rehabilitation therapy reported a higher IIEF-5 score than before (change score=6.5 points, 95% CI: 2.54 to 10.46, p value=0.0013).ConclusionDespite some heterogeneity and limited high-quality research, this study concludes that patients suffering from any type of PRF have an increased risk of developing ED. Oral intake of PDE-5-I for the purpose of penile rehabilitation therapy increases IIEF-5 scores and may relevantly influence quality-of-life in these patients.PROSPERO registration numberCRD42020169699.

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“…Conventionally, suprapubic diversion with delayed urethroplasty can always be considered for patients with anterior urethral injuries, if necessary. The advancement in endoscopy has led to EER emerging as a rival minimally invasive treatment option for patients with PFUI [ 8 , 9 ], but the role of EER in the acute management of blunt straddle injuries is controversial [ 2 , 6 , 9 – 11 ]. We herein report our experience with EER for acute management of blunt straddle injuries to the bulbar urethra in a level one trauma center in China.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra: a single-center retrospective study

Wang

Bao

et al. 2022

BMC Surg

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Background The optimal acute management of patients with blunt straddle injury to the bulbar urethra remains in question. Conventionally, suprapubic diversion with delayed urethroplasty can always be considered, if necessary, but the role of early endoscopic realignment (EER) in the acute management of blunt straddle injuries to bulbar urethra is controversial. We report our clinical experience and outcomes with EER for patients with straddle injury to the bulbar urethra in a level one trauma center. Methods We retrospectively reviewed 44 male patients who were transferred to our trauma center between January 2013 and January 2019 for acute management of blunt straddle injury to the perineum leading to bulbar urethra injuries. We reviewed the medical records of those patients to identify demographics, emergency management and clinical outcomes. Results The most common injury mechanism was falling onto the perineum (n = 27, 61.4%), followed by motorcycle accident (n = 11, 25.0%) and bicycle accident (n = 6, 13.6%). Of the 44 patients, 14 (31.8%) were partial bulbar urethral ruptures and 30 (68.2%) were complete bulbar urethral ruptures. 31 (70.5%) patients successfully underwent EER and 13 (29.5%) patients failed attempted EER. the difference between successful EER attempts and failed ones in term of injured urethral mucosa integrity was statistically significant (P = 0.035, OR 8.667,95% CI: 0.998–75.235). In patients who underwent successful EER, urethral stricture occurred after catheter removal at a median of 8 (1–28) months in 24 (77.4%) patients and the mean stricture length was 1.8 ± 0.8 (0.5–3.0), which was not statistically significant when compared with those who failed EER (P = 0.103). Overall, 21 out of 24 (87.5%) patients with strictures after EER were successfully managed by urethroplasty. Conclusions Although achieving a successful EER attempt is relatively easy for most patients with straddle injury to the bulbar urethra, it does not improve urethral healing significantly. Most patients with stricture formation after EER have to be cured with urethroplasty.

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Outcomes Following Primary Realignment Versus Suprapubic Cystostomy with Delayed Urethroplasty for Pelvic Fracture-Associated Posterior Urethral Injury: A Systematic Review with Meta-Analysis

Cited by 16 publications

References 31 publications

Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

Erectile dysfunction and penile rehabilitation after pelvic fracture: a systematic review and meta-analysis

Outcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra: a single-center retrospective study

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