Voiding and Sexual Dysfunctions after Pelvic Fracture Urethral Injuries Treated with either Initial Cystostomy and Delayed Urethroplasty or Immediate Primary Urethral Realignment

Aşçı, Ramazan; Sarıkaya, Savaş; Büyükalpelli, R.; Saylık, Acun; Yılmaz, Ahmet; Yildiz, Sevim

doi:10.1080/003655999750015826

Cited by 68 publications

(16 citation statements)

References 18 publications

(29 reference statements)

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“…The goal of management is to realign the urethra whilst minimising the risks of ED, incontinence and subsequent urethral stricture [4] ; Table 1 [13–41] and Fig. 1 summarise the findings of the above complications in early endoscopic realignment (EER), early open primary realignment, and STDU in studies from 1990 to the present.…”

Section: Introductionmentioning

confidence: 99%

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The management of the acute setting of pelvic fracture urethral injury (realignment vs. suprapubic cystostomy alone)

Warner

Santucci

2015

Arab Journal of Urology

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BackgroundIn patients with pelvic fracture urethral injury there are two options for management: First, to realign as an early primary realignment over a catheter; and second, to place a suprapubic tube with delayed urethroplasty of the inevitable stricture.MethodsWe reviewed previous reports from 1990 to the present, comparing early endoscopic realignment, early open realignment and suprapubic tube placement, to determine the rates of incontinence, erectile dysfunction and stricture formation.ResultsTwenty-nine articles were identified. The rates of erectile dysfunction, incontinence, and stricture formation, respectively, were: for early endoscopic realignment, 20.5%, 5.8% and 43.8%; for open realignment over a catheter, 16.7%, 4.7% and 48.9%; and for a suprapubic tube and delayed urethroplasty 13.7%, 5.0%, and 89.0%. A one-way anova showed no difference in the mean rate of erectile dysfunction (P = 0.53) or incontinence (P = 0.73), and only stricture formation was significantly different (P < 0.1).ConclusionThe rates of incontinence and erectile dysfunction are similar between the groups. Only the rate of stricture formation was higher in the suprapubic tube and delayed urethroplasty group.

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Section: Introductionmentioning

confidence: 99%

“…Once the PFUI is diagnosed most authors still attempt a single, gentle catheter placement at the bedside or in the operating room, by a urologist [24,38,39] . If this fails, then there are various endoscopic techniques available.…”

Section: Introductionmentioning

confidence: 99%

The management of the acute setting of pelvic fracture urethral injury (realignment vs. suprapubic cystostomy alone)

Warner

Santucci

2015

Arab Journal of Urology

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“…Early studies also suggested that ED and incontinence were higher in men undergoing PR. More recent studies suggest these complications are likely related to the underlying traumatic injury, rather than the choice of immediate urethral injury management ( 27 ) however, this has yet to be established in any longitudinal comparison study as proposed here.…”

Section: Discussionmentioning

confidence: 86%

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

Selph

Voelzke

et al. 2018

Transl. Androl. Urol.

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BackgroundPelvic fracture urethral injuries (PFUI) occur in up to 10% of pelvic fractures. It remains controversial whether initial primary urethral realignment (PR) after PFUI decreases the incidence of urethral obstruction and the need for subsequent urethral procedures. We present methodology for a prospective cohort study analyzing the outcomes of PR versus suprapubic cystostomy tube (SPT) after PFUI.MethodsA prospective cohort trial was designed to compare outcomes between PR (group 1) and SPT placement (group 2). Centers are assigned to a group upon entry into the study. All patients will undergo retrograde attempted catheter placement; if this fails a cystoscopy exam is done to confirm a complete urethral disruption and attempt at gentle retrograde catheter placement. If catheter placement fails, group 1 will undergo urethral realignment and group 2 will undergo SPT. The primary outcome measure will be the rate of urethral obstruction preventing atraumatic passage of a flexible cystoscope. Secondary outcome measures include: subsequent urethral interventions, post-injury complications, urethroplasty complexity, erectile dysfunction (ED) and urinary incontinence rates.ResultsPrior studies demonstrate PR is associated with a 15% to 50% reduction in urethral obstruction. Ninety-six men (48 per treatment group) are required to detect a 15% treatment effect (80% power, 0.05 significance level, 20% loss to follow up/death rate). Busy trauma centers treat complete PFUI approximately 1–6 times per year, thus our goal is to recruit 25 trauma centers and enroll patients for 3 years with a goal of 100 or more total patients with complete urethral disruption.ConclusionsThe proposed prospective multi-institutional cohort study should determine the utility of acute urethral realignment after PFUI.

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“…Asci et al published a retrospective cohort study in 1999 with 38 male patients managed with either SPT (n=18) or PR (n=20) with the primary aim of determining voiding and sexual dysfunction and evaluation of urethral stricture reformation ( 22 ). Urethral stricture rate was found to be statistically significant (83.3% SPT vs. 45.0% PR; P=0.014).…”

Section: Primary Realignment (Pr)mentioning

confidence: 99%

Current management of pelvic fracture urethral injuries: to realign or not?

Dixon¹,

Webb²,

Wenzel³

et al. 2018

Transl. Androl. Urol.

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The acute management of pelvic fracture urethral injuries (PFUIs) remains a controversial topic. Currently, suprapubic tube (SPT) placement with delayed repair or primary realignment (PR) represents the strategies used to treat patients. While many will advocate the use of one technique over the other, the 2014 American Urological Association (AUA) Guidelines give providers the option for the management PFUI. Current literature evaluates these two interventions, focusing on the incidence of re-stricture formation, erectile dysfunction, and urinary incontinence. Here we perform a comprehensive review of the current management for PFUI, as well as, discuss the limitations of the studies and need for more prospective studies on this debated topic.

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Voiding and Sexual Dysfunctions after Pelvic Fracture Urethral Injuries Treated with either Initial Cystostomy and Delayed Urethroplasty or Immediate Primary Urethral Realignment

Cited by 68 publications

References 18 publications

The management of the acute setting of pelvic fracture urethral injury (realignment vs. suprapubic cystostomy alone)

The management of the acute setting of pelvic fracture urethral injury (realignment vs. suprapubic cystostomy alone)

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

Current management of pelvic fracture urethral injuries: to realign or not?

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