Division of Urology, McMaster University, Hamilton, Ontario, Canada.
Division of Urology, McMaster University, Hamilton, Ontario, Canada.
Urology. 2014 Apr;83(4):924-9. doi: 10.1016/j.urology.2013.12.031.
To compare primary urethral realignment (PR) with suprapubic cystostomy (SPC) for the management of pelvic fracture-associated posterior urethral injuries with regards to rates of stricture, erectile dysfunction, and urinary incontinence.
Two electronic databases (MEDLINE and EMBASE) were searched with the assistance of a librarian. Title, abstract, and full text screening was carried out by 2 independent reviewers, with discrepancies resolved by consensus. Narrative reviews, surveys, and historical articles were excluded. Only studies reporting a direct comparison of PR vs SPC for the management of posterior urethral injuries associated with blunt trauma in adults were included. Quality assessment of the included articles was performed in duplicate. Stricture incidence was evaluated for all included studies, as were erectile dysfunction and incontinence rates when reported. All outcomes were treated as dichotomous data with calculation of odds ratio and were pooled using a random effects model with Review Manager 5.1.
Our comprehensive search yielded 161 unique articles. Nine articles were included in the final meta-analysis. Stricture rate was significantly lower in the PR group (odds ratio [OR] = 0.12, 95% confidence interval [CI] 0.04-0.41, P <.001). There was no significant difference between the 2 interventions with regards to erectile dysfunction (OR = 1.19, 95% CI 0.73-1.92, P = .49) or incontinence (OR = 0.75, 95% CI 0.38-1.48, P = .41).
PR appears to reduce the incidence of stricture formation after pelvic fracture-associated posterior urethral injuries as compared with SPC.
比较耻骨上膀胱造口术（SPC）与经尿道会师复位术（PR）治疗骨盆骨折后尿道损伤的效果，主要比较狭窄、勃起功能障碍和尿失禁的发生率。
在图书馆员的协助下，我们在两个电子数据库（MEDLINE 和 EMBASE）中进行了搜索。由 2 名独立审查员进行标题、摘要和全文筛选，如果有分歧，则通过协商解决。排除综述、调查和历史文章。仅纳入报告 PR 与 SPC 治疗成人钝性创伤后尿道损伤的直接比较的研究。由 2 名审查员独立对纳入的文章进行质量评估。所有纳入的研究均评估了狭窄发生率，当报告了勃起功能障碍和尿失禁率时，也评估了这些发生率。所有结局均视为二分类数据，计算比值比，并使用 Review Manager 5.1 软件进行随机效应模型汇总。
我们全面搜索得到了 161 篇独特的文章。最终纳入 9 篇文章进行荟萃分析。PR 组的狭窄发生率显著较低（比值比[OR] = 0.12，95%置信区间[CI] 0.04-0.41，P <.001）。2 种干预措施在勃起功能障碍（OR = 1.19，95% CI 0.73-1.92，P =.49）或尿失禁（OR = 0.75，95% CI 0.38-1.48，P =.41）方面无显著差异。
与 SPC 相比，PR 似乎可降低骨盆骨折后尿道损伤后狭窄形成的发生率。
