title: The case against primary endoscopic realignment of pelvic fracture urethral injuries.
abstract: OBJECTIVE
  To review previous reports and present our experience on the outcomes after treating pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) vs. placing a suprapubic tube (SPT) with elective bulbomembranous anastomotic urethroplasty (BMAU).
  
  
  METHODS
  We reviewed previous reports and identified articles that reported outcomes after PER vs. SPT and elective BMAU for patients who sustained PFUIs. We also present our institutional experience of treating patients who were referred after undergoing either form of treatment.
  
  
  RESULTS
  The success rates for PER after PFUI are wide-ranging (11-86%), with variable definitions for a successful outcome. At our institution, for patients treated by SPT/BMAU, the mean time to a definitive resolution of stenosis was dramatically shorter (6 months, range 3-15) than for those treated with PER (122 months, range 4-574; P < 0.01). The vast majority of patients treated by PER required multiple endoscopic urethral interventions (median 4, range 1-36;P < 0.01) and/or had various other adverse events that were rare among the SPT/BMAU group (14/17, 82%, vs. 2/23, 9%;P < 0.05).
  
  
  CONCLUSIONS
  While PER occasionally results in urethral patency with no need for further intervention, the risk of delay in definitive treatment and the potential for adverse events have led to a preference for SPT and elective BMAU at our institution.
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Tausch
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
keywords: BMAU, bulbomembranous anastomotic urethroplasty; PER, primary endoscopic realignment; PFUI, pelvic fracture urethral injury; Pelvic fracture; Primary endoscopic realignment; SPT, suprapubic tube; Stricture; Urethral injury; Urethroplasty