A multicenter prospective cohort study of endoscopic urethral realignment versus suprapubic cystostomy after complete pelvic fracture urethral injury.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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McCormick Benjamin J, Keihani Sorena, Hagedorn Judith, Selph J Patrick, Figler Bradley D, Johnsen Niels V, da Silva Rodrigo Donalisio, Broghammer Joshua A, Gupta Shubham, Miller Brandi, Burks Frank N, Eswara Jairam, Osterberg E Charles, Carney Kenneth J, Erickson Bradley A, Gretzer Matthew B, Chung Paul H, Harris Catherine R, Murphy Gregory P, Rusilko Paul, Shridharani Anand, Benson Cooper, Alwaal Amjad, Blaschko Sarah D, Breyer Benjamin N, Amend Gregory M, McKibben Maxim, Elliott Sean P, Schwartz Ian W, Simhan Jay, Vanni Alex J, Moses Rachel A, Myers Jeremy B
Аннотация
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.
LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.