title: Unintended negative consequences of primary endoscopic realignment for men with pelvic fracture urethral injuries.
abstract: OBJECTIVE
  We evaluated the clinical course of patients with pelvic fracture urethral injury referred to our institution to elucidate the differences between initial management strategies.
  
  
  METHODS
  We retrospectively reviewed our institutional review board approved, prospectively maintained urethroplasty database from 2007 to 2013. Patients with pelvic fracture urethral injury were stratified into 2 groups based on initial treatment before referral. Group 1 (21 of 38, 55%) was treated with suprapubic tube placement alone followed by elective bulbomembranous anastomotic urethroplasty and group 2 (17 of 38, 45%) underwent early primary endoscopic realignment. We recorded the number of endoscopic interventions and time from injury to successful definitive treatment. Data regarding stricture length, reconstruction technique and treatment outcomes were analyzed.
  
  
  RESULTS
  Among 766 urethroplasties performed during the study interval 38 (5%) consecutive pelvic fracture urethral injury cases were identified with complete information available and all underwent repair with excision with primary anastomosis. For suprapubic tube/bulbomembranous anastomotic urethroplasty cases the mean time to definitive resolution of stenosis was dramatically shorter (7 months, range 3 to 15) compared to primary endoscopic realignment cases (122 months, range 4 to 574; p <0.01). The majority of patients treated with primary endoscopic realignment required multiple endoscopic urethral interventions (median 4, range 1 to 36; p <0.01) and/or experienced various other adverse events which were rarely noted in the suprapubic tube/bulbomembranous anastomotic urethroplasty group (14 of 17 [82%] vs 2 of 21 [10%], p <0.05).
  
  
  CONCLUSIONS
  Treatment of pelvic fracture urethral disruption injuries with primary endoscopic realignment appears to be associated with unintended negative consequences including additional interventions and a prolonged clinical course.
authors: Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
authors: Timothy J
authors: TJ
authors: Tausch
authors: Department of Urology, UT Southwestern Medical Center, Dallas, Texas. Electronic address: allen.morey@utsouthwestern.edu.
authors: Allen F
authors: AF
authors: Morey
authors: Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
authors: J Francis
authors: JF
authors: Scott
authors: Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
authors: Jay
authors: J
authors: Simhan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000009:adverse effects*; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D014521:Urethra / Q000293:injuries* / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D055815:Young Adult
keywords: endoscopy; pelvis; urethral stricture; wound healing; wounds and injuries