Abstract: PD29-12
Sources of Funding: none

Introduction

Female urethral distraction injuries are rare and most commonly associated with pelvic fracture. We sought to systematically review the literature to determine the optimal management of this rare injury.

Methods

Using Meta-analysis Of Observational Studies in Epidemiology (M.O.O.S.E) criteria, we searched Cochrane, Pubmed and OVID databases for all articles available before June 30, 2016 using the terms “female pelvic fracture urethroplasty,” “female urethral distraction,” “female pelvic fracture urethral injury,” “female pelvic fracture urethra girls.” Three reviewers (CF, JA, DP) independently reviewed the titles, abstracts, and articles. We excluded articles based on animal models, transgender surgery, obstetric trauma, cancer or if they did not pertain to the treatment of female urethral injuries.

Results

We identified 162 individual articles from the databases. 51 articles met our criteria for full review. There were 158 female patients with urethral trauma, with almost twice as many children (? 18 years) as compared to adults (>18years), 99 vs 59. Of these injuries, 83 were managed with immediate repair via primary alignment (17) or anastomotic repair (66) and 75 were managed with delayed repair. Rates of urethral stenosis and fistula were highest after primary alignment. Urethral integrity appears to be similar following both primary anastomosis and delayed repair; however, patients experienced significantly more incontinence and vaginal stenosis following delayed repair. Those patients who underwent delayed urethral repair were more likely to undergo more extensive reconstructive surgery than those who underwent primary repair. _x000D_

Conclusions

There is a paucity of data in the literature on the optimal management of female urethral distraction defects. Based on our review of the available literature, primary anastomotic repair of a female urethral distraction defect via a vaginal approach appears optimal. This contrasts with the management of male pelvic fracture-related urethral distraction defects, in which primary anastomotic repair is considered injurious, and primary alignment is considered optimal.

Funding

none