The Outcomes of Pelvic Fracture Urethral Injuries Stratified by Urethral Injury Severity: A Prospective Multi-institutional Genitourinary Trauma Study (MiGUTS)

• DOI: 10.1016/j.urology.2022.09.006
• Publication Date: 2022-09-21T13:26:13Z
• Authors: Kiarad Fendereski; Benjamin J. McCor...; Sorena Keihani; Judith C. Hagedorn; Bryan Voelzke; J. Patrick Selph; Bradley D. Figler; Niels V. Johnsen; Rodrigo Donalisio...; Joshua A. Broghammer; Shubham Gupta; Brandi Miller; Frank N. Burks; Jairam R. Eswara; E. Charles Osterberg; Kenneth J. Carney; Brad A. Erickson; Matthew B. Gretzer; Paul H. Chung; Catherine R. Harris; Gregory P. Murphy; Paul Rusilko; Katherine T. Ande...; Anand Shridharani; Cooper R. Benson; Amjad Alwaal; Sarah D Blaschko; Benjamin N. Breyer; Maxim McKibben; Ian W. Schwartz; Jay Simhan; Alex J. Vanni; Rachel A. Moses; Jeremy B. Myers
• Keywords: Pelvic fracture; Blunt trauma

To determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury.Adult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score.There were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (P < 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (P < 0.001).In PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed.