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Unintended negative consequences of primary endoscopic realignment for men with pelvic fracture urethral injuries. | LitMetric

AI Article Synopsis

  • The study focused on comparing two initial management strategies for patients with pelvic fracture urethral injuries at a medical institution from 2007 to 2013.
  • Patients were divided into two groups: one receiving a suprapubic tube followed by surgery and the other undergoing early endoscopic realignment.
  • Results showed that the surgical group had a significantly shorter recovery time and fewer complications compared to those treated with endoscopic realignment, which often required multiple procedures and led to more adverse effects.

Article Abstract

Purpose: We evaluated the clinical course of patients with pelvic fracture urethral injury referred to our institution to elucidate the differences between initial management strategies.

Materials And Methods: We retrospectively reviewed our institutional review board approved, prospectively maintained urethroplasty database from 2007 to 2013. Patients with pelvic fracture urethral injury were stratified into 2 groups based on initial treatment before referral. Group 1 (21 of 38, 55%) was treated with suprapubic tube placement alone followed by elective bulbomembranous anastomotic urethroplasty and group 2 (17 of 38, 45%) underwent early primary endoscopic realignment. We recorded the number of endoscopic interventions and time from injury to successful definitive treatment. Data regarding stricture length, reconstruction technique and treatment outcomes were analyzed.

Results: Among 766 urethroplasties performed during the study interval 38 (5%) consecutive pelvic fracture urethral injury cases were identified with complete information available and all underwent repair with excision with primary anastomosis. For suprapubic tube/bulbomembranous anastomotic urethroplasty cases the mean time to definitive resolution of stenosis was dramatically shorter (7 months, range 3 to 15) compared to primary endoscopic realignment cases (122 months, range 4 to 574; p <0.01). The majority of patients treated with primary endoscopic realignment required multiple endoscopic urethral interventions (median 4, range 1 to 36; p <0.01) and/or experienced various other adverse events which were rarely noted in the suprapubic tube/bulbomembranous anastomotic urethroplasty group (14 of 17 [82%] vs 2 of 21 [10%], p <0.05).

Conclusions: Treatment of pelvic fracture urethral disruption injuries with primary endoscopic realignment appears to be associated with unintended negative consequences including additional interventions and a prolonged clinical course.

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Source
http://dx.doi.org/10.1016/j.juro.2014.06.069DOI Listing

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