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

Translational Andrology and Urology
Rachel A Mosesfrom the Trauma and Urologic Reconstruction Network of Surgeons (TURNS)

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% reductio...Continue Reading

Citations

Mar 22, 2019·International Journal of Urology : Official Journal of the Japanese Urological Association·Akio Horiguchi
Dec 13, 2019·World Journal of Emergency Surgery : WJES·Federico CoccoliniUNKNOWN WSES-AAST Expert Panel
Apr 23, 2021·Seminars in Interventional Radiology·Robert Wolf, Sara Smolinski-Zhao

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