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Chen YT, Wang TM, Cheng CT, Tee YS, Liao CH, Hsieh CH, Fu CY. Timing of male urethral injury treatment in patients with polytrauma: A retrospective study. Injury 2024; 55:111339. [PMID: 38575396 DOI: 10.1016/j.injury.2024.111339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/01/2024] [Accepted: 01/14/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Male urethral injuries are uncommon, and the ideal timing of the definitive treatment remains controversial. This study aimed to compare the outcomes of early and delayed interventions (1 month or more after the injury) for male urethral injuries. PATIENT AND METHODS We conducted a retrospective review of the medical records of 67 male patients with urethral injuries treated at our institution between 2011 and 2020. We examined patient age, injury severity score (ISS), abbreviated injury scale, mechanism, location and severity of injury, presence of pelvic fractures, surgical interventions, timing of treatment, and complications. We analysed factors associated with urinary complications based on the location of urethral injury. Additionally, we performed a subset analysis of patients with severe injuries (ISS≥16) to assess the impact of delayed surgery. RESULTS Overall, 47 %, 37 %, and 27 % of patients in the delayed treatment group (N = 30) had urethral stricture (US), erectile dysfunction (ED), and/or urinary incontinence (UI). These rates were greater than the 22 % US, 3 % ED, and 11 % UI rates in the early treatment group (N = 37). The subgroup analysis revealed that patients with anterior urethral injury (AUI) who underwent delayed treatment (N = 18) tended to be more severely injured (ISS, 19 vs 9, p = 0.003) and exhibited higher rates of US (44% vs 21 %, p = 0.193) and ED (39% vs 0 %, p = 0.002) than those who received early treatment (N = 24). In the case of posterior urethral injury (PUI), the delayed treatment group (N = 13) had higher rates of US (50% vs 23 %, p = 0.326), ED (33% vs 8 %, p = 0.272), and UI (42% vs 0 %, p = 0.030) than the early treatment group. Regarding study limitations, more than 45 % of the enrolled patients were severely injured (ISS≥16), which may have potentially influenced the timing of urethral injury repair. CONCLUSIONS The treatment of male urethral injuries may be delayed due to concurrent polytrauma and other associated injuries. However, delayed treatment is associated with higher rates of urinary complications. Early treatment of urethral injuries may be beneficial to male patients with urethral trauma, even in cases of severe injury.
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Affiliation(s)
- Yu-Ting Chen
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
| | - Ta-Min Wang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chi-Tung Cheng
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Yu-San Tee
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC.
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chi-Hsun Hsieh
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
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Serafetinidis E, Campos-Juanatey F, Hallscheidt P, Mahmud H, Mayer E, Schouten N, Sharma DM, Waterloos M, Zimmermann K, Kitrey ND. Summary Paper of the Updated 2023 European Association of Urology Guidelines on Urological Trauma. Eur Urol Focus 2024; 10:475-485. [PMID: 37968186 DOI: 10.1016/j.euf.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/10/2023] [Accepted: 08/31/2023] [Indexed: 11/17/2023]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Panel for Urological Trauma has produced guidelines in order to assist medical professionals in the management of urological trauma in adults for the past 20 yr. It must be emphasised that clinical guidelines present the best evidence available to the experts, but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients regarding other parameters such as experience and available facilities. Guidelines are not mandates and do not purport to be a legal standard of care. OBJECTIVE To present a summary of the 2023 version of the EAU guidelines on the management of urological trauma. EVIDENCE ACQUISITION A systematic literature search was conducted from 1966 to 2022, and articles with the highest certainty evidence were selected. It is important to note that due to its nature, genitourinary trauma literature still relies heavily on expert opinion and retrospective series. EVIDENCE SYNTHESIS Databases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between May 1, 2021 and April 29, 2022. A total of 1236 unique records were identified, retrieved, and screened for relevance. CONCLUSIONS The guidelines provide an evidence-based approach for the management of urological trauma. PATIENT SUMMARY Trauma is a serious public health problem with significant social and economic costs. Urological trauma is common; traffic accidents, falls, intrapersonal violence, and iatrogenic injuries are the main causes. Developments in technology, continuous training of medical professionals, and improved care of polytrauma patients reduce morbidity and maximise the opportunity for quick recovery.
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Affiliation(s)
| | | | | | - Husny Mahmud
- Department of Urology, Sheba Medical Centre, Tel-Hashomer, Israel
| | - Erik Mayer
- Department of Surgery & Cancer, Imperial College London, London, UK; Department of Urology, The Royal Marsden Hospital, London, UK
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Marjan Waterloos
- Division of Urology, Gent University Hospital, Gent, Belgium; Division of Urology, AZ Maria Middelares, Gent, Belgium
| | - Kristin Zimmermann
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Noam D Kitrey
- Department of Urology, Sheba Medical Centre, Tel-Hashomer, Israel.
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Rovere G, Smakaj A, Perna A, De Mauro D, Are L, Meccariello L, Fidanza A, Erasmo R, Falez F, Maccauro G, Liuzza F. Correlation between traumatic pelvic ring injuries and sexual dysfunctions: a multicentric retrospective study. INTERNATIONAL ORTHOPAEDICS 2023; 47:1407-1414. [PMID: 36930257 DOI: 10.1007/s00264-023-05767-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Among the functional impairments associated with pelvic ring injuries (PRI), sexual dysfunction (SD) is a common clinical issue. The aim of this study is to investigate correlations between traumatic PRI, genitourinary, and sexual dysfunctions, for a proper multidisciplinary treatment. METHODS We performed an observational, multicentric study, from January 2020 to 2022. We conducted a follow-up after surgery at three, six, 12, and 24 months by measuring the Female Sexual Functioning Index (FSFI), the International Index of Erectile Function (IIEF), the Arizona Sexual Experience Scale (ASEX), the Majeed Score, and the SF-12. Descriptive statistics was conducted on T-test, Whelc's test, and one-way ANOVA which were performed when appropriate. RESULTS A total of 76 patients (mean age 42.17 ± 15 years) were included in the study and allocated into three groups (A, B, and C). Tile A group revealed good sexual outcomes, similar to that of healthy patients. Tile B group demonstrated worsen SD than the previous group. In Tile C group, there was a longer average duration of the orthopaedic surgery when compared to group B. However, in terms of SDs, statistical significance could not be demonstrated between groups C and B. CONCLUSIONS We observed a progressive spontaneous recovery of sexual function, corresponding to each PRI group. Moreover, men classified as B2 had milder SDs than B1 male patients.
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Affiliation(s)
- Giuseppe Rovere
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amarildo Smakaj
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Orthopaedics and Traumatology, Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Domenico De Mauro
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Are
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Meccariello
- Department Orthopaedics and Traumatology, AORN San Pio, Benevento, Italy
| | - Andrea Fidanza
- Department of Orthopaedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Rocco Erasmo
- Department of Orthopaedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Francesco Falez
- Department of Orthopaedics and Traumatology, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Giulio Maccauro
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Liuzza
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.
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Jiao W, Yu W, Wang Y, Zhang J, Wang Y, He H, Shi G. Fibrinogen/poly(l-lactide-co-caprolactone) copolymer scaffold: A potent adhesive material for urethral tissue regeneration in urethral injury treatment. Regen Ther 2023; 22:136-147. [PMID: 36793307 PMCID: PMC9923042 DOI: 10.1016/j.reth.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/02/2022] [Accepted: 12/13/2022] [Indexed: 01/30/2023] Open
Abstract
Since a scarcity of sufficient grafting materials, several complications can arise after urothelial defect reconstruction surgery, including severe hypospadias. Accordingly, developing alternative therapies, such as urethral restoration via tissue engineering are needed. In the present study, we developed a potent adhesive and repairing material using fibrinogen-poly(l-lactide-co-caprolactone) copolymer (Fib-PLCL) nanofiber scaffold to achieve effective urethral tissue regeneration after seeding with epithelial cells on the surface. The in vitro result found the Fib-PLCL scaffold promoted the attachment and viability of epithelial cells on their surface. The increased expression levels of cytokeratin and actin filaments were observed in Fib-PLCL scaffold than PLCL scaffold. The in vivo urethral injury repairing potential of Fib-PLCL scaffold was evaluated using a rabbit urethral replacement model. In this study, a urethral defect was surgically excised and replaced with the Fib-PLCL and PLCL scaffolds or autograft. As expected, the animals healed well after surgery in the Fib-PLCL scaffold group, and no significant strictures were identified. As expected, the cellularized Fib/PLCL grafts have induced the luminal epithelialization, urethral smooth muscle cell remodelling, and capillary development all at the same time. Histological analysis revealed that the urothelial integrity in the Fib-PLCL group had progressed to that of a normal urothelium, with enhanced urethral tissue development. Based on the results, the present study suggests that the prepared fibrinogen-PLCL scaffold is more appropriate for urethral defect reconstruction.
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Affiliation(s)
- Wei Jiao
- Department of Urology, Shanghai Fifth People's Hospital, Fudan University, No. 801 Heqing Road, Minhang District, Shanghai 200240, China
| | - Wandong Yu
- Department of Urology, Shanghai Fifth People's Hospital, Fudan University, No. 801 Heqing Road, Minhang District, Shanghai 200240, China
| | - Yangyun Wang
- Department of Urology, Shanghai Fifth People's Hospital, Fudan University, No. 801 Heqing Road, Minhang District, Shanghai 200240, China
| | - Jun Zhang
- Department of Urology, Shanghai Fifth People's Hospital, Fudan University, No. 801 Heqing Road, Minhang District, Shanghai 200240, China
| | - Yang Wang
- Department of Urology, Shanghai Fifth People's Hospital, Fudan University, No. 801 Heqing Road, Minhang District, Shanghai 200240, China
| | - Hongbing He
- Shanghai Songli Biotechnology Co., Ltd, Shanghai 201206, China
| | - Guowei Shi
- Department of Urology, Shanghai Fifth People's Hospital, Fudan University, No. 801 Heqing Road, Minhang District, Shanghai 200240, China
- Corresponding author.
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Fendereski K, McCormick BJ, Keihani S, Hagedorn JC, Voelzke B, Selph JP, Figler BD, Johnsen NV, da Silva RD, Broghammer JA, Gupta S, Miller B, Burks FN, Eswara JR, Osterberg EC, Carney KJ, Erickson BA, Gretzer MB, Chung PH, Harris CR, Murphy GP, Rusilko P, Anderson KT, Shridharani A, Benson CR, Alwaal A, Blaschko SD, Breyer BN, McKibben M, IanSchwartz, Simhan J, Vanni AJ, Moses RA, Myers JB. The Outcomes of Pelvic Fracture Urethral Injuries Stratified by Urethral Injury Severity: A Prospective Multi-institutional Genitourinary Trauma Study (MiGUTS). Urology 2022; 170:197-202. [PMID: 36152870 DOI: 10.1016/j.urology.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES 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). CONCLUSIONS 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.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jairam R Eswara
- St. Elizabeth's Medical Center, Boston University School of Medicine.
| | | | | | | | | | - Paul H Chung
- Sidney Kimmel Medical College of Thomas Jefferson University.
| | | | | | | | | | | | | | | | | | | | | | - IanSchwartz
- Division of Urology Hennepin County Medical Center, University of Minnesota.
| | | | | | | | - Jeremy B Myers
- University of Utah, Department of Surgery (Primary Investigator).
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Klemm J, Marks P, Dahlem R, Riechardt S, Fisch M, Vetterlein MW. [Contemporary management of pelvic fracture urethral injuries]. Urologe A 2022; 61:602-608. [PMID: 35476111 DOI: 10.1007/s00120-022-01833-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 12/01/2022]
Abstract
Posterior urethral injuries in men usually result from polytrauma with pelvic fractures and severe associated injuries. If left untreated, posterior urethral injury can lead to severe complications and even death, so precise diagnosis should be made when urethral injury is suspected. The cardinal symptom of urethral injury is blood leakage from the meatus. Retrograde urethrography is the diagnostic tool of choice. In the case of complete urethral avulsion, the formation of a urethral stricture due to pronounced scarring fibrosis is inevitable. In principle, various therapeutic approaches are available. Often, urinary diversion by means of a transurethral or suprapubic catheter is performed first. However, there is also the possibility of direct endoscopic or open urethral realignment with subsequent temporary catheterization. Immediate surgical reconstruction is useful only in exceptional cases of simultaneous bladder neck or rectal injury. In cases of complete urethral avulsion, secondary transperineal bulboprostatic reanastomosis at the interval after three months of suprapubic continuous drainage with excellent success rate is the gold standard and can be supplemented with ancillary maneuvers if necessary to ensure a tension-free anastomosis.
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Affiliation(s)
- Jakob Klemm
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Phillip Marks
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Roland Dahlem
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Silke Riechardt
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Margit Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Malte W Vetterlein
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Lefaivre KA, Roffey DM, Guy P, O'Brien PJ, Broekhuyse HM. Quantifying Urinary and Sexual Dysfunction After Pelvic Fracture. J Orthop Trauma 2022; 36:118-123. [PMID: 34407035 DOI: 10.1097/bot.0000000000002247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To quantify the severity of urinary and sexual dysfunction and to evaluate the relationship between urinary and sexual dysfunction, injury, and treatment factors in patients with pelvic fracture. DESIGN Prospective cohort study. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS One hundred thirteen patients with surgically treated pelvic fracture (65.5% OTA/AO 61B fractures; 7 open fractures; 74 men). INTERVENTIONS Surgical pelvic stabilization. MAIN OUTCOME MEASURES The 36-Item Short Form Health Survey and International Consultation Incontinence Questionnaire responses were collected at baseline, 6 months, and 1, 2, and 5 years. Patients were scored on symptoms of voiding and incontinence, and filling (for women), to derive urinary function. Sexual function was scored as a single domain. Both genders reported urinary and sexual bothersome symptoms. Regression analysis was used to isolate the importance of predictive factors on urinary and sexual function, urinary and sexual bother, and their impact on quality of life. RESULTS Patients with pelvic fracture have significant urinary and sexual dysfunction, which is sustained or worsens over time. Male urinary function was predicted by Injury Severity Score (P = 0.03) and 61C fracture (odds ratio: 3.23, P = 0.04). Female urinary function was predicted by urinary tract injury at admission (odds ratio: 7.57, P = 0.03). Neurologic injury and anterior fixation were identified as significant predictors for male sexual function and sexual bother, whereas urological injuries were important in predicting female urinary and sexual bother (P < 0.01). Sexual function (P = 0.02) and sexual bother (P < 0.001) were important predictors of overall mental well-being in men. CONCLUSIONS Urinary and sexual dysfunction are prevalent and sustained in men and women and do not follow the prolonged slow recovery trajectory seen in physical function. Male urinary and sexual dysfunction was closely tied to neurologic injury, whereas female urinary and sexual dysfunction was predicted by the presence of a urinary tract injury. Urinary and sexual dysfunction were important to overall mental well-being in men. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Darren M Roffey
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Peter J O'Brien
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Henry M Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
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8
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Horiguchi A, Edo H, Shinchi M, Ojima K, Hirano Y, Ito K, Shinmoto H. Role of magnetic resonance imaging in the management of male pelvic fracture urethral injury. Int J Urol 2022; 29:919-929. [PMID: 34986514 DOI: 10.1111/iju.14779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
The management of male pelvic fracture urethral injury remains a urological challenge. Pelvic fracture urethral injury can be associated with sequelae, such as urethral gap, erectile dysfunction and urinary incontinence. Delayed anastomotic urethroplasty, the gold standard treatment for urethral gaps caused by pelvic fracture urethral injuries, is technically demanding, and reconstructive urologists should preoperatively obtain as much detailed anatomical information as possible. A combination of antegrade and retrograde urethrography is the fundamental preoperative evaluation, but it cannot accurately assess the urethral gap length, the degree of lateral prostatic displacement, the anatomical relationship of the urethra with its surrounding structures (such as the rectum and dorsal venous complex) or periurethral problems (such as minor fistulae or cavitation). To make up for these limitations of urethrography, magnetic resonance imaging has emerged as a non-invasive, multiplanar and high-resolution modality for the evaluation of pelvic fracture urethral injury. Magnetic resonance imaging has excellent soft-tissue contrast, and can clearly show the urethra and periurethral tissues without the effects of radiation, thus enabling clinicians to anticipate the required ancillary techniques for delayed anastomotic urethroplasty and to predict functional outcomes, such as erectile function and urinary continence, after delayed anastomotic urethroplasty. This review discusses the role of magnetic resonance imaging in the evaluation of pelvic fracture urethral injury and its impact on patient management.
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Affiliation(s)
- Akio Horiguchi
- Departments of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiromi Edo
- Department of, Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Shinchi
- Departments of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kenichiro Ojima
- Departments of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yusuke Hirano
- Departments of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Keiichi Ito
- Departments of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiroshi Shinmoto
- Department of, Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
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Tae BS, Yoon YE, Na W, Oh KJ, Park SY, Park JY, Moon HS. Epidemiologic study of bladder and urethral injury in Korea: A nationwide population-based study. Investig Clin Urol 2022; 63:92-98. [PMID: 34983127 PMCID: PMC8756144 DOI: 10.4111/icu.20210065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/27/2021] [Accepted: 09/30/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose We aimed to analyze the characteristics and management of bladder and urethral injuries in Korea by use of the National Health Insurance Service (NHIS) database. Materials and Methods Data from the NHIS database representative of all cases of Korean bladder injury (n=4,631) and urethral injury (n=17,858) reported between 2012 and 2016 were analyzed. We used the International Classification of Diseases, 10th revision, clinical modification codes to identify the diagnoses. Results A total of 491 males (1.97/100,000) and 590 females (2.39/100,000) experienced bladder injury in 2012, and 449 males (1.76/100,000) and 624 females (2.47/100,000) in 2016. The risk of bladder injury was higher in female than in male (hazard ratio [HR], 1.267; p<0.001). The annual incidence of bladder injury did not increase (HR, 0.992; p=0.409). A total of 2,886 (62.3%) patients were managed with conservative treatment, and 1,745 (37.7%) patients underwent surgical treatment. A total of 4,114 males (16.5/100,000) and 285 females (1.2/100,000) had urethral injury in 2012, while 4,465 males (17.5/100,000) and 303 females (1.2/100,000) had urethral injury in 2016. The incidence of urethral injury is increasing annually (HR, 1.010; p=0.036). Conclusions The incidence of urethral injury increased continuously over the years studied, whereas that of bladder injury remained unchanged in Korea. The incidence of bladder injury was higher in females, and more than 90% of total urethral injuries were reported in males. This is the first study to evaluate the epidemiology of bladder and urethral injury using a nationwide population database.
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Affiliation(s)
- Bum Sik Tae
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Woong Na
- Department of Urology, National Medical Center, Seoul, Korea
| | - Kyung Jin Oh
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Yul Park
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Young Park
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hong Sang Moon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea.
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10
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Neu S, Remondini T, Hird A, Locke JA, Herschorn S, Kodama R. A Retrospective Look at Term Outcomes After Definitive Surgical Repair for Traumatic Pelvic Fracture Urethral Injuries - Does Initial Management Make a Difference? Urology 2021; 160:203-209. [PMID: 34843746 DOI: 10.1016/j.urology.2021.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the long-term outcomes of initial management of pelvic fracture urethral injury (PFUI) in a large cohort of trauma patients undergoing urethral reconstruction. MATERIALS AND METHODS 119 patients underwent urethral reconstruction by a single surgeon for PFUI at our center between 1998-2018. We compared initial PFUI management - primary realignment vs suprapubic tube (SPT) insertion alone. Multivariable Cox proportional hazard analysis was used to assess the association between primary intervention and the risk of having a complication. RESULTS PFUI was initially managed with primary realignment (57%) or SPT alone (43%). Ultimately, all patients underwent a primary perineal urethral anastomosis after a median of 7 months (IQR: 5-14). Overall, 27 patients (23%) had 1 or more long-term complications after a median 25 months (IQR:7-66), including urethral stricture, de novo erectile dysfunction, and urinary incontinence. On multivariable analysis, initial PFUI management did not predict for complications. CONCLUSION No difference was found in long-term outcomes after urethral reconstruction when comparing initial PFUI management of primary realignment vs SPT insertion.
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Affiliation(s)
- Sarah Neu
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Taylor Remondini
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Hird
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer A Locke
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ronald Kodama
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Keating J. Commentary on: "Definitive Fixation Outcomes of Open Tibial Shaft Fractures: Systematic Review and Network Meta-analysis". J Orthop Trauma 2021; 35:569-571. [PMID: 34173358 DOI: 10.1097/bot.0000000000002131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- John Keating
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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12
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Sun HW, Kim H, Jeon CH, Jang JH, Kim GH, Park CI, Park SJ, Kim JH, Yeom SR. Incidence and Clinical Features of Urethral Injuries with Pelvic Fractures in Males: A 6-Year Retrospective Cohort Study at a Single Institution in South Korea. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2020.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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13
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Syarif, Palinrungi MA, Kholis K, Syahrir S, Pakan AP, Faruk M. Primary anastomosis for complete bulbar urethral rupture with rectal laceration caused by straddle injury: A case report. Int J Surg Case Rep 2021; 82:105848. [PMID: 33862408 PMCID: PMC8076690 DOI: 10.1016/j.ijscr.2021.105848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/21/2022] Open
Abstract
About 10% of traumatic injury patients have genitourinary involvement. Immediate exploration and urethral reconstruction is indicated in urethral trauma. Urethra rupture with anorectal laceration can be treated with primary anastomosis.
Introduction The initial management of urethral trauma remains disputed, and there are several suitable techniques, including delayed repair and suprapubic urinary diversion as well as primary endoscopic or open alignments. The treatment choice used depends on the rupture’s location and length as well as the accompanying trauma. Case presentation A 33-year-old male patient was referred to the department of emergency, with the chief complaint of inability to void experienced 1 day before being admitted, after falling from a height of approximately three meters. There was a laceration to the perineum 3 cm long to the rectum, with no active bleeding. After the incident, the patient could not void, but the lower abdomen was not painful. Upon retrograde urethrography examination, contrast extravasation of the bulbous urethra was seen through the anorectal laceration. Immediate debridement and repair for the anorectal wound, then primary anastomosis for the bulbous urethra, was performed. Discussion The likelihood of an injury to the anterior urethra increases with certain clinical features, including blood in the urethral meatus, palpable bladder distention, and a butterfly appearance on the perineum. Immediate exploration and reconstruction of the urethra is recommended in urethral traumas associated with penile fractures and non-life-threatening penetrating injuries. Furthermore, small lacerations are repaired primarily, while total ruptures are treated with anastomosis. Conclusion Proper identification and management of urethral rupture determines the outcome. Initial urethral trauma management is disputed; however, a bulbous urethra rupture with anorectal lacerations can be treated safely and effectively with primary anastomosis.
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Affiliation(s)
- Syarif
- Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Muhammad Asykar Palinrungi
- Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Khoirul Kholis
- Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Syakri Syahrir
- Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | | | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
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14
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Agarwal H, Katiyar A, Priyadarshani P, Kumar S, Gupta A, Sagar S. Magnitude and outcomes of complex perineal injury - A retrospective analysis of five years' data from a Level 1 trauma centre. Trop Doct 2021; 51:344-349. [PMID: 33683163 DOI: 10.1177/0049475521998185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Complex perineal injuries pose a major diagnostic and therapeutic challenge to trauma surgeons. A retrospective review of the hospital records of 29 patients with complex perineal injury following blunt trauma was done. Demographic profile, management and outcomes were collected. Quality of life analysis was conducted for patients with complex perineal injuries who were discharged. The most predominant mode of injury was a road crash: being a pedestrian run over by a heavy motor vehicle. Pelvic fracture was seen in 20, anorectal involvement in 22 and urogenital injuries in 14. Urgent surgical debridement was done in all patients, faecal diversion in 27 and urinary diversion in 14. There were nine deaths, three from haemorrhage, and the remainder from sepsis and multi-organ dysfunction. Complex perineal injury remains a major cause of morbidity and mortality in trauma patients. There is a need to ensure adequate rehabilitation services for such patients.
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Affiliation(s)
- Harshit Agarwal
- Senior Resident, Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Anand Katiyar
- Senior Resident, Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Pratyusha Priyadarshani
- Assistant Professor, Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Subodh Kumar
- Professor, Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Amit Gupta
- Professor, Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Sushma Sagar
- Professor, Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
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15
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Imaging spectrum of traumatic urinary bladder and urethral injuries. Abdom Radiol (NY) 2021; 46:681-691. [PMID: 32725483 DOI: 10.1007/s00261-020-02679-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
Urinary bladder and urethral injuries usually occur as part of multiple injuries in polytrauma patients. These injuries are easily overlooked because the initial evaluation is focused on other life-threatening injuries such as traumatic brain injury, hemopneumothorax or hemoperitoneum. Although the urinary bladder and urethral injuries are not life-threatening, they pose the risk of long-term morbidity which can be burdensome. These complications include urinary incontinence, voiding dysfunction, urethrocutaneous fistula, urethral stricture and erectile dysfunction. Computed tomography (CT) findings of urinary bladder and urethral injuries are usually subtle. Retrograde fluoroscopic/CT cystography and urethrography remain the mainstay imaging techniques for complete evaluation, diagnosis, staging, and follow-up of these traumatic injuries. In this review, we discuss the pathophysiology and imaging spectrum of urinary bladder and urethral injuries with an emphasis on the classification schemes. Familiarity with the pelvic anatomy and the injury pattern leads to the prompt diagnosis, accurate classification and appropriate management, which have been associated with better prognosis.
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16
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Wang Z, Li Q, Wang P, Yang M. Biodegradable drug-eluting urethral stent in limiting urethral stricture formation after urethral injury: An experimental study in rabbit. J BIOACT COMPAT POL 2020. [DOI: 10.1177/0883911520940002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In this study, a reproducible urethral injury animal model was developed and the role of the biodegradable drug-eluting urethral stent in limiting urethral stricture formation after urethral injury was evaluated. A total of 22 rabbits were used, and 20 rabbits were randomly chosen to develop urethral injury animal model. Bulbar urethral injury was made by a self-designed explosion device in the 20 rabbits. The urethral injury animal model was then randomly assigned to 2 groups of 10 each, which received a treatment of biodegradable paclitaxel-eluting urethral stent or only end-to-end anastomosis. Other two rabbits served as normal control group. Stents were surgically implanted into the injured urethras of rabbits under direct vision. Reparative effects, including stent degradation, were evaluated by urethroscopy, retrograde urethrography, and histology at different intervals at weeks 4, 8, and 12. In stent-free group, 8 of 10 rabbits developed obvious urethral stricture which was demonstrated by urethroscopy and retrograde urethrography, while in biodegradable paclitaxel-eluting stent group, urethral stricture was absent in all animals (p < 0.05). Histological follow-up indicated that the drug-eluting stents can also minimize the inflammatory reactions and fibrosis formation compared with the stent-free groups. Scanning electron microscope demonstrated that the biodegradable drug-eluting stent can gradually degrade in 12 weeks. The biodegradable paclitaxel-eluting urethral stent is effective in limiting urethral stricture formation after urethral injury.
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Affiliation(s)
- Zhongxin Wang
- Department of Traditional Chinese Medicine, The First Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Military Postgraduate Medical College, Beijing, People’s Republic of China
- Department of Urology, Hainan Hospital of Chinese PLA (People’s Liberation Army) General Hospital, Sanya, People’s Republic of China
| | - Qiongqiong Li
- Department of Nursing and Preschool Education, Shougang Technician College, Beijing, People’s Republic of China
| | - Pengchao Wang
- Department of Urology, Hainan Hospital of Chinese PLA (People’s Liberation Army) General Hospital, Sanya, People’s Republic of China
| | - Minghui Yang
- Department of Traditional Chinese Medicine, The First Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Military Postgraduate Medical College, Beijing, People’s Republic of China
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17
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Mojtabaie P, Redmond CE, Lunt CR, Gibney B, Murray N, Louis L, Nicolaou S. Lower Urinary Tract Injuries: A Guide for the Emergency Radiologist. Can Assoc Radiol J 2020; 72:557-563. [PMID: 32391715 DOI: 10.1177/0846537120913875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Traumatic lower urinary tract injuries are uncommon and mainly occur in patients with severe trauma and multiple abdominopelvic injuries. In the presence of other substantial injuries, bladder and urethral injuries may be overlooked and cause significant morbidity and mortality. Therefore, it is important that radiologists are familiar with mechanisms and injuries that are high risk for bladder and urethral trauma. We review the imaging findings associated with these injuries and the appropriate modalities and techniques to further evaluate the patient and accurately diagnose these injuries. Computed tomography cystography and conventional retrograde urethrography are effective tools in identifying injuries to the lower urinary tract and play a crucial role in patient care and prognosis.
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Affiliation(s)
- Parmiss Mojtabaie
- Division of Emergency Radiology, 8167Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ciaran E Redmond
- Division of Emergency Radiology, 8167Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Christopher R Lunt
- Division of Emergency Radiology, 8167Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Brian Gibney
- Division of Emergency Radiology, 8167Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Nicolas Murray
- Division of Emergency Radiology, 8167Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Luck Louis
- Division of Emergency Radiology, 8167Vancouver General Hospital, Vancouver, British Columbia, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Division of Emergency Radiology, 8167Vancouver General Hospital, Vancouver, British Columbia, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, British Columbia, Canada
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