title: Management of pelvic fracture-associated urethral injuries: A survey of Canadian urologists.
abstract: BACKGROUND
  The management of pelvic fracture-associated urethral injuries (PFUI) is not standardized and optimal management is controversial. We surveyed Canadian urologists about their experiences and opinions regarding optimal management of PFUI.
  
  
  METHODS
  Canadian urologists were surveyed via an anonymous, bilingual, web-based, 12-item questionnaire. A total of 735 Canadian urologists were invited to participate via email distributed by the Canadian Urological Association.
  
  
  RESULTS
  Of the 146 urologists who participated (19.9% response rate), the majority practice at a trauma centre (53.2%), but manage only 1-5 PFUI/year (71.5%). Most participants (82.6%) favour primary realignment compared to suprapubic (SP) tube with delayed repair (15.3%) and immediate reconstruction (2.1%). Compared to SP diversion and delayed repair, the majority of participants believe primary realignment is associated with equivocal incontinence (61.2%) and erectile dysfunction rates (75.8%), but has lower stricture rates (73.0%). Among respondents who perform primary realignment, 45.4% concurrently place a SP tube, while 54.6% do not. While 91% believe SP tubes do not increase the risk of pelvic hardware infections, 31.6% report that orthopedic surgeons alter their management of pelvic fractures in the presence of a SP tube.
  
  
  CONCLUSIONS
  Most Canadian urologist respondents - even those practicing at trauma centres - manage very few PFUIs/year. There is reasonable consensus among respondents that primary realignment is favourable to delayed or immediate reconstruction, but discordance on whether or not to place concurrent SP tubes. The urological and orthopedic consequences of SP tubes in the management of traumatic urological injuries warrant further investigation.
authors.affiliation: Division of Urology, McMaster University, Hamilton, ON, Canada.
authors.forename: Nathan Colin
authors.initials: NC
authors.lastname: Wong
authors.affiliation: Division of Urology, McMaster University, Hamilton, ON, Canada.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Allard
authors.affiliation: Division of Urology, McMaster University, Hamilton, ON, Canada.
authors.forename: Shawn
authors.initials: S
authors.lastname: Dason
authors.affiliation: Division of Orthopedic Surgery, McMaster University, Hamilton, ON, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Farrugia
authors.affiliation: Division of Orthopedic Surgery, McMaster University, Hamilton, ON, Canada.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.affiliation: Division of Urology, McMaster University, Hamilton, ON, Canada.
authors.forename: Timothy O
authors.initials: TO
authors.lastname: Davies