World journal of urology · 2025
A systematic review and meta-analysis of surgical approaches in pelvic fracture-associated urethral injury: primary endoscopic realignment versus delayed urethroplasty.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Owen Kevin, Joe Wilbert, Palgunadi I Nyoman, Soebhali Boyke
Аннотация
BACKGROUND: Pelvic fracture urethral injury (PFUI) can produce considerable morbidity, including urethral stricture, urinary incontinence, and erectile dysfunction. Optimal management of PFUI is unclear, however, the current gold standard is placement of a suprapubic cystostomy with delayed urethroplasty (SCDU) performed several months later. Another option is primary realignment (PR) with urethral catheter. Through a systematic review and meta-analysis, we aimed to compare the outcomes of PR and SCDU in patients with PFUI.
METHODS: A systematic search across databases (PubMed, ScienceDirect, Web of Science and Cochrane Library) was conducted without time or language limitations. Both medical subject heading and free text terms as well as variations of root word were searched. Randomised controlled trials (RCTs), nonrandomised comparative studies and single-arm case series were included. Data were narratively synthesised considering methodological and clinical heterogeneity. The risk of bias of each included study was assessed.
RESULTS: From 1,780 identified articles, 11 studies encompassing 412 PR and 357 SCDU met our eligibility criteria. All studies were non-randomized comparative studies. In general, included studies were of moderately quality. Follow-up durations ranged from 1 to 264 months. Meta-analysis demonstrated that PR and SCDU had comparable rates of stricture (OR: 1.23, [95%CI 0.24-6.37], p = 0.80), urinary incontinence (OR: 1.02, [95%CI 0.59-1.79], p = 0.94), and ED (OR: 0.97, [95%CI 0.64-1.46], p = 0.88).
CONCLUSION: To conclude, this study found that primary realignment did not yield superior outcomes in terms of stricture formation, urinary incontinence, and rates of erectile dysfunction compared to SCDU. It is noteworthy that the predominant inclusion of non-randomized retrospective studies in this analysis introduces a potential for bias. Additional high-quality research, particularly prospective studies and randomized controlled trials are needed to validate these findings.
METHODS: A systematic search across databases (PubMed, ScienceDirect, Web of Science and Cochrane Library) was conducted without time or language limitations. Both medical subject heading and free text terms as well as variations of root word were searched. Randomised controlled trials (RCTs), nonrandomised comparative studies and single-arm case series were included. Data were narratively synthesised considering methodological and clinical heterogeneity. The risk of bias of each included study was assessed.
RESULTS: From 1,780 identified articles, 11 studies encompassing 412 PR and 357 SCDU met our eligibility criteria. All studies were non-randomized comparative studies. In general, included studies were of moderately quality. Follow-up durations ranged from 1 to 264 months. Meta-analysis demonstrated that PR and SCDU had comparable rates of stricture (OR: 1.23, [95%CI 0.24-6.37], p = 0.80), urinary incontinence (OR: 1.02, [95%CI 0.59-1.79], p = 0.94), and ED (OR: 0.97, [95%CI 0.64-1.46], p = 0.88).
CONCLUSION: To conclude, this study found that primary realignment did not yield superior outcomes in terms of stricture formation, urinary incontinence, and rates of erectile dysfunction compared to SCDU. It is noteworthy that the predominant inclusion of non-randomized retrospective studies in this analysis introduces a potential for bias. Additional high-quality research, particularly prospective studies and randomized controlled trials are needed to validate these findings.