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

Rachel A Moses; John Patrick Selph; Bryan B Voelzke; Joshua Piotrowski; Jairam R Eswara; Bradley A Erickson; Shubham Gupta; Roger R Dmochowski; Niels V Johnsen; Anand Shridharani; Sarah D Blaschko; Sean P Elliott; Ian Schwartz; Catherine R Harris; Kristy Borawski; Bradley D Figler; E Charles Osterberg III; Frank N Burks; William Bihrle III; Brandi Miller; Richard A Santucci; Benjamin N Breyer; Brian Flynn; Ty Higuchi; Fernando J Kim; Joshua A Broghammer; Angela P Presson; Jeremy B Myers

doi:10.21037/tau.2017.11.07

$An American Association for the Surgery of Trauma (AAST) prospective multi-center research protocol: outcomes of urethral realignment versus suprapubic cystostomy after pelvic fracture urethral injury$

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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

Rachel A Moses, John Patrick Selph, Bryan B Voelzke, Joshua Piotrowski, Jairam R Eswara, Bradley A Erickson, Shubham Gupta, Roger R Dmochowski, Niels V Johnsen, Anand Shridharani, …

Translational andrology and urology, Vol.7(4), pp.512-520

08/2018

DOI: 10.21037/tau.2017.11.07

PMCID: PMC6127553

PMID: 30211041

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Abstract

Pelvic 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. A 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. Prior 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. The proposed prospective multi-institutional cohort study should determine the utility of acute urethral realignment after PFUI.

urethroplasty

primary realignment

urethral injury

pelvic fracture urethral injury (PFUI)

Genitourinary trauma

Details

Title: Subtitle: 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
Creators: Rachel A Moses - Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
John Patrick Selph - Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
Bryan B Voelzke - Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA, USA
Joshua Piotrowski - Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA
Jairam R Eswara - Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
Bradley A Erickson - Department of Urology, University of Iowa, Iowa City, IA, USA
Shubham Gupta - Department of Urology, University of Kentucky, Lexington, KY, USA
Roger R Dmochowski - Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
Niels V Johnsen - Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
Anand Shridharani - Department of Urology, University of Tennessee College of Medicine, Chattanooga, TN, USA
Sarah D Blaschko - Division of Urology, Alameda Health System, Oakland, CA, USA
Sean P Elliott - Division of Urology, Department of Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
Ian Schwartz - Division of Urology, Department of Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
Catherine R Harris - Santa Clara Valley Medical Center, San Jose, CA, USA
Kristy Borawski - Department of Urology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
Bradley D Figler - Department of Urology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
E Charles Osterberg III - Department of Surgery, University of Texas, Dell Medical School, Austin, TX, USA
Frank N Burks - Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
William Bihrle III - Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
Brandi Miller - Department of Urology, Detroit Medical Center, Detroit, MI, USA
Richard A Santucci - Department of Urology, Detroit Medical Center, Detroit, MI, USA
Benjamin N Breyer - Department of Urology, University of California-San Francisco, San Francisco, CA, USA
Brian Flynn - Department of Surgery (Urology), University of Colorado School of Medicine, Aurora, CO, USA
Ty Higuchi - Department of Surgery (Urology), University of Colorado School of Medicine, Aurora, CO, USA
Fernando J Kim - Department of Surgery (Urology), University of Colorado School of Medicine, Aurora, CO, USA
Joshua A Broghammer - Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
Angela P Presson - Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
Jeremy B Myers - Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
Resource Type: Journal article
Publication Details: Translational andrology and urology, Vol.7(4), pp.512-520
DOI: 10.21037/tau.2017.11.07
PMID: 30211041
PMCID: PMC6127553
NLM abbreviation: Transl Androl Urol
ISSN: 2223-4691
eISSN: 2223-4691
Publisher: China
Language: English
Date published: 08/2018
Academic Unit: Urology
Record Identifier: 9984051578102771

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