A multicenter prospective cohort study of endoscopic urethral realignment versus suprapubic cystostomy after complete pelvic fracture urethral injury

Benjamin J. McCormick; Sorena Keihani; Judith Hagedorn; J. Patrick Selph; Bradley D. Figler; Niels V. Johnsen; Rodrigo Donalisio da Silva; Joshua A. Broghammer; Shubham Gupta; Brandi Miller; Frank N. Burks; Jairam Eswara; E. Charles Osterberg; Kenneth J. Carney; Bradley A. Erickson; Matthew B. Gretzer; Paul H. Chung; Catherine R. Harris; Gregory P. Murphy; Paul Rusilko; Anand Shridharani; Cooper Benson; Amjad Alwaal; Sarah D. Blaschko; Benjamin N. Breyer; Gregory M. Amend; Maxim McKibben; Sean P. Elliott; Ian W. Schwartz; Jay Simhan; Alex J. Vanni; Rachel A. Moses; Jeremy B. Myers

doi:10.1097/TA.0000000000003774

$A multicenter prospective cohort study of endoscopic urethral realignment versus suprapubic cystostomy after complete pelvic fracture urethral injury$

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A multicenter prospective cohort study of endoscopic urethral realignment versus suprapubic cystostomy after complete pelvic fracture urethral injury

Benjamin J. McCormick, Sorena Keihani, Judith Hagedorn, J. Patrick Selph, Bradley D. Figler, Niels V. Johnsen, Rodrigo Donalisio da Silva, Joshua A. Broghammer, Shubham Gupta, Brandi Miller, …

The journal of trauma and acute care surgery, Vol.94(2), pp.344-349

02/01/2023

DOI: 10.1097/TA.0000000000003774

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Abstract

BACKGROUND: Pelvic fracture urethral injury (PFUI) occurs in up to 10% of pelvic fractures. There is mixed evidence supporting early endoscopic urethral realignment (EUR) over suprapubic tube (SPT) placement and delayed urethroplasty. Some studies show decreased urethral obstruction with EUR, while others show few differences. We hypothesized that EUR would reduce the rate of urethral obstruction after PFUI. METHODS: Twenty-six US medical centers contributed patients following either an EUR or SPT protocol from 2015 to 2020. If retrograde cystoscopic catheter placement failed, patients were included and underwent either EUR or SPT placement based on their institution's assigned treatment arm. Endoscopic urethral realignment involved simultaneous antegrade/retrograde cystoscopy to place a catheter across the urethral injury. The primary endpoint was development of urethral obstruction. Fisher's exact test was used to analyze the relationship between PFUI management and development of urethral obstruction.RESULTS: There were 106 patients with PFUI; 69 (65%) had complete urethral disruption and failure of catheter placement with retrograde cystoscopy. Of the 69 patients, there were 37 (54%) and 32 (46%) in the EUR and SPT arms, respectively. Mean age was 37.0 years (SD, 16.3 years) years, and mean follow-up was 463 days (SD, 280 days) from injury. In the EUR arm, 36 patients (97%) developed urethral obstruction compared with 30 patients (94%) in the SPT arm (p = 0.471). Urethroplasty was performed in 31(87%) and 29 patients (91%) in the EUR and SPT arms, respectively (p = 0.784).CONCLUSION: In this prospective multi-institutional study of PFUI, EUR was not associated with a lower rate of urethral obstruction or need for urethroplasty when compared with SPT placement. Given the potential risk of EUR worsening injuries, clinicians should consider SPT placement as initial treatment for PFUI when simple retrograde cystoscopy is not successful in placement of a urethral catheter

Surgery

Critical Care Medicine

General & Internal Medicine

Life Sciences & Biomedicine

Science & Technology

Details

Title: Subtitle: A multicenter prospective cohort study of endoscopic urethral realignment versus suprapubic cystostomy after complete pelvic fracture urethral injury
Creators: Benjamin J. McCormick - University of Utah
Sorena Keihani - University of Utah
Judith Hagedorn - Harborview Medical Center
J. Patrick Selph - University of Alabama at Birmingham
Bradley D. Figler - University of North Carolina.
Niels V. Johnsen - Vanderbilt University Medical Center
Rodrigo Donalisio da Silva - University of Colorado Denver
Joshua A. Broghammer - University of Kansas Medical Center
Shubham Gupta - Case Western Reserve University
Brandi Miller - Detroit Medical Center
Frank N. Burks - Beaumont Hospital
Jairam Eswara - St. Elizabeth's Medical Center
E. Charles Osterberg - The University of Texas at Austin
Kenneth J. Carney - Grady Memorial Hospital
Bradley A. Erickson - University of Iowa Hospitals and Clinics
Matthew B. Gretzer - Banner - University Medical Center Tucson
Paul H. Chung - Thomas Jefferson University
Catherine R. Harris - Santa Clara Valley Medical Center
Gregory P. Murphy - Washington University in St. Louis School of Medicine
Paul Rusilko - University of Pittsburgh Medical Center
Anand Shridharani - University of Tennessee at Chattanooga
Cooper Benson - Tulane University
Amjad Alwaal - Rutgers, The State University of New Jersey
Sarah D. Blaschko - Alameda Health System
Benjamin N. Breyer - University of California, San Francisco
Gregory M. Amend - Icahn School of Medicine at Mount Sinai
Maxim McKibben - Carolinas Medical Center
Sean P. Elliott - University of Minnesota
Ian W. Schwartz - Hennepin County Medical Center
Jay Simhan - Einstein Healthcare Network
Alex J. Vanni - Lahey Medical Center
Rachel A. Moses - Dartmouth–Hitchcock Medical Center
Jeremy B. Myers - University of Utah
Resource Type: Journal article
Publication Details: The journal of trauma and acute care surgery, Vol.94(2), pp.344-349
DOI: 10.1097/TA.0000000000003774
ISSN: 2163-0755
eISSN: 2163-0763
Publisher: Lippincott Williams & Wilkins
Number of pages: 6
Language: English
Date published: 02/01/2023
Academic Unit: Urology
Record Identifier: 9984380461902771

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