Primary realignment vs suprapubic cystostomy for the management of pelvic fracture-associated urethral injuries: a systematic review and meta-analysis. 2014

Keith Barrett, and Luis H Braga, and Forough Farrokhyar, and Timothy O Davies
Division of Urology, McMaster University, Hamilton, Ontario, Canada. Electronic address: keithbarrett1@gmail.com.

OBJECTIVE To compare primary urethral realignment (PR) with suprapubic cystostomy (SPC) for the management of pelvic fracture-associated posterior urethral injuries with regards to rates of stricture, erectile dysfunction, and urinary incontinence. METHODS Two electronic databases (MEDLINE and EMBASE) were searched with the assistance of a librarian. Title, abstract, and full text screening was carried out by 2 independent reviewers, with discrepancies resolved by consensus. Narrative reviews, surveys, and historical articles were excluded. Only studies reporting a direct comparison of PR vs SPC for the management of posterior urethral injuries associated with blunt trauma in adults were included. Quality assessment of the included articles was performed in duplicate. Stricture incidence was evaluated for all included studies, as were erectile dysfunction and incontinence rates when reported. All outcomes were treated as dichotomous data with calculation of odds ratio and were pooled using a random effects model with Review Manager 5.1. RESULTS Our comprehensive search yielded 161 unique articles. Nine articles were included in the final meta-analysis. Stricture rate was significantly lower in the PR group (odds ratio [OR] = 0.12, 95% confidence interval [CI] 0.04-0.41, P <.001). There was no significant difference between the 2 interventions with regards to erectile dysfunction (OR = 1.19, 95% CI 0.73-1.92, P = .49) or incontinence (OR = 0.75, 95% CI 0.38-1.48, P = .41). CONCLUSIONS PR appears to reduce the incidence of stricture formation after pelvic fracture-associated posterior urethral injuries as compared with SPC.

UI MeSH Term Description Entries
D007172 Erectile Dysfunction The inability in the male to have a PENILE ERECTION due to psychological or organ dysfunction. Impotence,Male Impotence,Male Sexual Impotence,Dysfunction, Erectile,Impotence, Male,Impotence, Male Sexual,Sexual Impotence, Male
D008297 Male Males
D010384 Pelvic Bones Bones that constitute each half of the pelvic girdle in VERTEBRATES, formed by fusion of the ILIUM; ISCHIUM; and PUBIC BONE. Coxal Bone,Hip Bone,Innominate Bones,Bone, Coxal,Bone, Hip,Bone, Innominate,Bone, Pelvic,Bones, Coxal,Bones, Hip,Bones, Innominate,Bones, Pelvic,Coxal Bones,Hip Bones,Innominate Bone,Pelvic Bone
D012107 Research Design A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. Experimental Design,Data Adjustment,Data Reporting,Design, Experimental,Designs, Experimental,Error Sources,Experimental Designs,Matched Groups,Methodology, Research,Problem Formulation,Research Methodology,Research Proposal,Research Strategy,Research Technics,Research Techniques,Scoring Methods,Adjustment, Data,Adjustments, Data,Data Adjustments,Design, Research,Designs, Research,Error Source,Formulation, Problem,Formulations, Problem,Group, Matched,Groups, Matched,Matched Group,Method, Scoring,Methods, Scoring,Problem Formulations,Proposal, Research,Proposals, Research,Reporting, Data,Research Designs,Research Proposals,Research Strategies,Research Technic,Research Technique,Scoring Method,Source, Error,Sources, Error,Strategies, Research,Strategy, Research,Technic, Research,Technics, Research,Technique, Research,Techniques, Research
D003559 Cystostomy Surgical creation of an opening (stoma) in the URINARY BLADDER for drainage. Suprapubic Cystostomy,Vesicostomy,Cystostomies,Cystostomies, Suprapubic,Cystostomy, Suprapubic,Suprapubic Cystostomies,Vesicostomies
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013521 Urologic Surgical Procedures, Male Surgery performed on the male genitalia. Male Urologic Surgery,Male Urologic Surgical Procedure,Male Urologic Surgical Procedures,Male Urological Surgical Procedure,Male Urological Surgical Procedures,Procedure, Urologic Surgical, Male,Procedure, Urological Surgical, Male,Procedures, Urologic Surgical, Male,Procedures, Urological Surgical, Male,Surgery, Male Urologic,Surgical Procedure, Urologic, Male,Surgical Procedure, Urological, Male,Surgical Procedures, Urologic, Male,Surgical Procedures, Urological, Male,Urologic Surgery, Male,Urologic Surgical Procedure, Male,Urological Surgery, Male,Urological Surgical Procedure, Male,Urological Surgical Procedures, Male,Male Urological Surgery,Surgery, Male Urological
D014521 Urethra A tube that transports URINE from the URINARY BLADDER to the outside of the body in both the sexes. It also has a reproductive function in the male by providing a passage for SPERM. External Urethral Sphincter,External Urinary Sphincter,Internal Urethral Sphincter,Internal Urinary Sphincter,Internal Vesical Sphincter,Urethral Sphincters,External Urethral Sphincters,External Urinary Sphincters,Internal Urethral Sphincters,Internal Urinary Sphincters,Internal Vesical Sphincters,Sphincter, External Urethral,Sphincter, External Urinary,Sphincter, Internal Urethral,Sphincter, Internal Urinary,Sphincter, Internal Vesical,Sphincter, Urethral,Urethral Sphincter,Urethral Sphincter, External,Urethras,Urinary Sphincter, External,Urinary Sphincter, Internal,Vesical Sphincter, Internal
D014525 Urethral Stricture Narrowing of any part of the URETHRA. It is characterized by decreased urinary stream and often other obstructive voiding symptoms. Urethral Stenosis,Anterior Urethral Stricture,Posterior Urethral Stricture,Urethral Stricture, Anterior,Urethral Stricture, Posterior,Anterior Urethral Strictures,Posterior Urethral Strictures,Stenoses, Urethral,Stenosis, Urethral,Stricture, Urethral,Strictures, Urethral,Urethral Stenoses,Urethral Strictures,Urethral Strictures, Anterior,Urethral Strictures, Posterior
D014546 Urinary Catheterization Passage of a CATHETER into the URINARY BLADDER or kidney. Catheterization, Ureteral,Catheterization, Urethral,Catheterization, Urinary,Foley Catheterization,Ureteral Catheterization,Urethral Catheterization,Catheterization, Foley,Catheterizations, Ureteral,Catheterizations, Urethral,Catheterizations, Urinary,Ureteral Catheterizations,Urethral Catheterizations,Urinary Catheterizations

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