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    PFUI treatment has benefits despite low initial success

    Early endoscopic realignment may reduce infection risk, researcher says

    Boston—Early endoscopic realignment (EER) of pelvic fracture urethral injuries (PFUI) is associated with a low initial success rate, but the procedure does not hinder the success of subsequent urethroplasty and has other merits that may make it worthwhile, according to urologists from the University of Washington, Seattle.

    At the AUA annual meeting in Boston, they presented findings from an updated review of their experience with EER. The retrospective study included 32 patients who had undergone EER between 2004 and 2016 for a pelvic fracture urethral injury that was secondary to blunt pelvic trauma. The findings were subsequently published online in Urology (Oct. 25, 2017).

    Success, defined as having no secondary procedure or the ability to pass a cystoscope across the area of injury or surgical anastomosis, was achieved in only three patients (9%). An earlier analysis performed in 2011 that included 19 patients found a success rate of 21%.

    Read: What steps do you take to avoid surgical complications?

    In the updated series, two patients were lost to follow-up and one patient who failed EER was managed with a suprapubic tube. Of the 26 remaining patients, 25 eventually had a successful outcome with either secondary dilation/direct visual internal urethrotomy (DVIU) or urethroplasty following failed dilation/DVIU.

    “Whether surgeons should perform EER or place a suprapubic tube and plan delayed treatment for pelvic fracture urethral injuries is a topic of ongoing debate. Surgeons who are opposed to EER argue that it is not worth doing considering that it is unlikely to be successful,” said Paul H. Chung, MD, fellow in genitourinary trauma and reconstructive surgery at the University of Washington Medical Center.

    Next: EER improves safety of secondary surgery


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