SIU/ICUD Consultation on Urethral Strictures: Pelvic Fracture Urethral Injuries

Gómez, Reynaldo; Mundy, Tony; Dubey, Deepak; El-Kassaby, Abdel Wahab; Firdaoessaleh,; Kodama, Ron; Santucci, Richard A.

doi:10.1016/j.urology.2013.09.023

Cited by 87 publications

(100 citation statements)

References 57 publications

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“…Pelvic fractures are generally categorized according to the direction of the force of injury, such as anteroposterior compression, lateral compression, vertical shear (Malgaigne fracture) or their combinations . Minor fractures rarely cause urethral injury, and most PFUIs result from massive blunt shearing force, and pelvic fractures with disruption of the pelvic ring . Although earlier data suggest that the incidence of PFUI is 10–25% of males with pelvic fracture, later data showed a much lower incidence (1.4–2%) .…”

Section: Pathophysiology and Mechanism Of Pfuimentioning

confidence: 99%

“…Pelvic fracture is usually caused by a high‐energy injury, such as a traffic accident or fall from heights, and places patients at risk of associated urethral injury, which is known as PFUI . PFUIs are relatively rare and are much more common in males, because the female urethra is shorter and more mobile than that of a male, and is almost completely protected by the pubic bone .…”

Section: Introductionmentioning

confidence: 99%

“…PFUIs are relatively rare and are much more common in males, because the female urethra is shorter and more mobile than that of a male, and is almost completely protected by the pubic bone . PFUIs can cause urinary outflow obstruction, extravasation and secondary sepsis in the acute setting, and can also result in significant morbidity, such as urethral stenosis, ED and urinary incontinence, which can be associated with lifelong disability . Because most patients with PFUIs are young, inappropriate treatment and/or delay in management not only leads to low QOL, but can also negatively influence social productivity .…”

Section: Introductionmentioning

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: Pathophysiology and Mechanism Of Pfuimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…7,14 However, success rates reported in primary realignment series are not well-defined and vary considerably, ranging from 11-86%. 8,9,14 Although the benefits remain debatable, those who advocate for primary realignment stress the importance of reestablishing urethral continuity to obviate the need for or difficulty of future urethoplasties. The strictures that do develop may be shorter in length and with the urethra aligned, the surgeon may successfully treat these patients endoscopically.…”

Section: Discussionmentioning

confidence: 99%

Management of pelvic fracture-associated urethral injuries: A survey of Canadian urologists

Wong

Allard

Dason

et al. 2017

CUAJ

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Introduction: The management of pelvic fracture-associated urethral injuries (PFUI) is not standardized and optimal management is controversial. We surveyed Canadian urologists about their experiences and opinions regarding optimal management of PFUI. Methods: Canadian urologists were surveyed via an anonymous, bilingual, web-based, 12-item questionnaire. A total of 735 Canadian urologists were invited to participate via email distributed by the Canadian Urological Association. Results: Of the 146 urologists who participated (19.9% response rate), the majority practice at a trauma centre (53.2%), but manage only 1-5 PFUI/year (71.5%). Most participants (82.6%) favour primary realignment compared to suprapubic (SP) tube with delayed repair (15.3%) and immediate reconstruction (2.1%). Compared to SP diversion and delayed repair, the majority of participants believe primary realignment is associated with equivocal incontinence (61.2%) and erectile dysfunction rates (75.8%), but has lower stricture rates (73.0%). Among respondents who perform primary realignment, 45.4% concurrently place a SP tube, while 54.6% do not. While 91% believe SP tubes do not increase the risk of pelvic hardware infections, 31.6% report that orthopedic surgeons alter their management of pelvic fractures in the presence of a SP tube. Conclusions: Most Canadian urologist respondents -even those practicing at trauma centres -manage very few PFUIs/year. There is reasonable consensus among respondents that primary realignment is favourable to delayed or immediate reconstruction, but discordance on whether or not to place concurrent SP tubes. The urological and orthopedic consequences of SP tubes in the management of traumatic urological injuries warrant further investigation.

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“…The presence of blood at the urethral meatus may suggest a urethral injury, and in these cases, a retrograde urethrogram (RUG) should be obtained prior to Foley catheterization [17]. Once passed, the presence of blood in the urine may indicate a bladder injury, and a cystogram should be performed [18,19].…”

Section: Discussionmentioning

confidence: 99%

Orthopedic Approach to the Early Management of Pelvic Injuries

Weaver

Heng

2015

Curr Trauma Rep

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High-energy pelvic fractures in trauma patients cause significant morbidity and mortality. A systematic approach to the early evaluation and management of these patients leads to improved outcomes. The initial care of patients with a displaced pelvic fracture and hemodynamic instability should focus upon three areas: 1) resuscitation, 2) bony stability, and 3) hemorrhage control. Aggressive resuscitation with blood products and clotting factors is paramount. The initial reduction of the pelvic ring and temporary stabilization can be achieved through the use of pelvic sheeting or binder placed in the field or trauma bay. Urgent surgical stabilization with external or internal fixation is often required. Hemorrhage control can be achieved through pelvic packing and/or angioembolization. The initial management of displaced pelvic fractures is multidisciplinary and should involve close collaboration between trauma surgery, orthopedic surgery, anesthesia, and interventional radiology.

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SIU/ICUD Consultation on Urethral Strictures: Pelvic Fracture Urethral Injuries

Cited by 87 publications

References 57 publications

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

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

Management of pelvic fracture-associated urethral injuries: A survey of Canadian urologists

Orthopedic Approach to the Early Management of Pelvic Injuries

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