Login to Access Video or Poster Abstract: MP79-08
Sources of Funding: None

Introduction

The initial management of pelvic fracture urethral injuries (PFUI) with early endoscopic realignment (EER) versus suprapubic tube (SPT) placement is controversial. At our institution, early endoscopic realignment (EER) is performed for all patients who undergo pelvic fracture repair. In our initial analysis from 2011, we evaluated 19 patients and reported a 21% success rate for EER. We sought to update our experience with EER following PFUI.

Methods

A retrospective review was performed of patients treated at our level 1 trauma center with EER for PFUI secondary to blunt pelvic trauma. EER was performed with a retrograde or a combined antegrade/retrograde approach with a cystoscope through the SPT tract. Failures of EER were defined as requiring a secondary procedure, permanent SPT management, or lost to follow up (LTF). Treatment success was defined as no secondary procedure or the ability to pass a cystoscope across the area of injury or surgical anastomosis.

Results

Thirty patients underwent EER at our institution between 2004-2016 with a mean follow up of 27 months (range 0-105). Mean time to realignment was 2 days (range 0-6). Delayed EER was scheduled with another surgical service in 22 patients (81%). Average operative time for EER was 46 minutes (range 6-100). No patient experienced complications from endoscopic realignment (i.e. pelvic abscess or orthopedic hardware infection). The catheter was removed on average 35 days (range 12-98) after EER. 26 patients (87%) returned with obstructive voiding symptoms (mean 27 days, range 2-109) requiring delayed surgical treatment and 1 patient was LTF. Using an intent-to-treat analysis, 27 patients (90%) failed EER (Figure). 15 patients underwent primary urethroplasty with 100% success. 2 patients elected permanent SPT management. 9 patients underwent primary endoscopic management with dilation or DVIU with 22% success (2/9). Of the 7 patients who failed endoscopic management, 6 patients underwent urethroplasty with 100% success and 1 patient was LTF.

Conclusions

Our updated overall success rate for EER was 10%. The low long term success rates of EER should be balanced with potential benefits such as decreased orthopedic hardware infection after SPT removal and improved alignment in the case a subsequent urethroplasty is required.

Funding

None