TY - JOUR
T1 - The Outcomes of Pelvic Fracture Urethral Injuries Stratified by Urethral Injury Severity
T2 - A Prospective Multi-institutional Genitourinary Trauma Study (MiGUTS)
AU - Fendereski, Kiarad
AU - McCormick, Benjamin J.
AU - Keihani, Sorena
AU - Hagedorn, Judith C.
AU - Voelzke, Bryan
AU - Selph, J. Patrick
AU - Figler, Bradley D.
AU - Johnsen, Niels V.
AU - da Silva, Rodrigo Donalisio
AU - Broghammer, Joshua A.
AU - Gupta, Shubham
AU - Miller, Brandi
AU - Burks, Frank N.
AU - Eswara, Jairam R.
AU - Osterberg, E. Charles
AU - Carney, Kenneth J.
AU - Erickson, Brad A.
AU - Gretzer, Matthew B.
AU - Chung, Paul H.
AU - Harris, Catherine R.
AU - Murphy, Gregory P.
AU - Rusilko, Paul
AU - Anderson, Katherine T.
AU - Shridharani, Anand
AU - Benson, Cooper R.
AU - Alwaal, Amjad
AU - Blaschko, Sarah D.
AU - Breyer, Benjamin N.
AU - McKibben, Maxim
AU - Schwartz, Ian W.
AU - Simhan, Jay
AU - Vanni, Alex J.
AU - Moses, Rachel A.
AU - Myers, Jeremy B.
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/12
Y1 - 2022/12
N2 - OBJECTIVE: To determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury.METHODS: Adult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score.RESULTS: There were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (P < 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (P < 0.001).CONCLUSION: In PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed.
AB - OBJECTIVE: To determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury.METHODS: Adult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score.RESULTS: There were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (P < 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (P < 0.001).CONCLUSION: In PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed.
KW - Adult
KW - Fractures, Bone/complications
KW - Humans
KW - Male
KW - Multiple Trauma/complications
KW - Pelvic Bones/injuries
KW - Prospective Studies
KW - Retrospective Studies
KW - Urethra/surgery
KW - Urethral Diseases/complications
KW - Urethral Obstruction/complications
UR - http://www.scopus.com/inward/record.url?scp=85140803048&partnerID=8YFLogxK
U2 - 10.1016/j.urology.2022.09.006
DO - 10.1016/j.urology.2022.09.006
M3 - Article
C2 - 36152870
AN - SCOPUS:85140803048
SN - 0090-4295
VL - 170
SP - 197
EP - 202
JO - Urology
JF - Urology
ER -