Primary Realignment vs Suprapubic Cystostomy for the Management of Pelvic Fracture–associated Urethral Injuries: A Systematic Review and Meta-analysis

• Published in: Urology (Ridgewood, N.J.) Vol. 83; no. 4; pp. 924 - 929
• Main Authors: Barrett, Keith, Braga, Luis H, Farrokhyar, Forough, Davies, Timothy O
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2014; Elsevier
• Subjects: Biological and medical sciences; Cystostomy - methods; Erectile Dysfunction - etiology; Fractures, Bone - complications; Humans; Injuries of the urinary system. Foreign bodies. Diseases due to physical agents; Male; Medical sciences; Nephrology. Urinary tract diseases; Pelvic Bones - pathology; Research Design; Traumas. Diseases due to physical agents; Treatment Outcome; Urethra - injuries; Urethra - surgery; Urethral Stricture - etiology; Urinary Catheterization; Urinary Incontinence - etiology; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urologic Surgical Procedures, Male - methods; Urology; Urethral traumatism; Nephrology; Urinary system disease; Urethral disease; Diseases of the osteoarticular system; Fracture; Urinary tract disease; Review; Urology; Metaanalysis; Clinical management; Pelvic cavity; Primary; Cystostomy; Comparative study; Bibliographic review
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2013.12.031

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). Conclusion PR appears to reduce the incidence of stricture formation after pelvic fracture–associated posterior urethral injuries as compared with SPC.