학술논문
The Outcomes of Pelvic Fracture Urethral Injuries Stratified by Urethral Injury Severity: A Prospective Multi-institutional Genitourinary Trauma Study (MiGUTS)
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article
Author
Fendereski, Kiarad; McCormick, Benjamin J; Keihani, Sorena; Hagedorn, Judith C; Voelzke, Bryan; 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 R; Osterberg, E Charles; Carney, Kenneth J; Erickson, Brad A; Gretzer, Matthew B; Chung, Paul H; Harris, Catherine R; Murphy, Gregory P; Rusilko, Paul; Anderson, Katherine T; Shridharani, Anand; Benson, Cooper R; Alwaal, Amjad; Blaschko, Sarah D; Breyer, Benjamin N; McKibben, Maxim; Schwartz, Ian W; Simhan, Jay; Vanni, Alex J; Moses, Rachel A; Myers, Jeremy B
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Abstract
ObjectiveTo 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.MethodsAdult 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.ResultsThere 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).ConclusionIn 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.