Wong Nathan Colin, Allard Christopher B, Dason Shawn, Farrugia Patricia, Bhandari Mohit, Davies Timothy O
Division of Urology, McMaster University, Hamilton, ON, Canada.
Division of Orthopedic Surgery, McMaster University, Hamilton, ON, Canada.
Can Urol Assoc J. 2017 Mar-Apr;11(3-4):E74-E78. doi: 10.5489/cuaj.4154. Epub 2017 Mar 16.
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.
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.
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.
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.
骨盆骨折相关尿道损伤（PFUI）的处理尚未标准化，最佳处理方法存在争议。我们就PFUI的最佳处理方法对加拿大泌尿外科医生的经验和观点进行了调查。
通过一份基于网络的、双语的、包含12个条目的匿名问卷对加拿大泌尿外科医生进行调查。通过加拿大泌尿外科协会发送电子邮件，邀请了总共735名加拿大泌尿外科医生参与。
146名参与调查的泌尿外科医生（回复率为19.9%）中，大多数在创伤中心执业（53.2%），但每年仅处理1 - 5例PFUI（71.5%）。与耻骨上（SP）管引流并延迟修复（15.3%）和即刻重建（2.1%）相比，大多数参与者（82.6%）倾向于一期复位。与SP转流和延迟修复相比，大多数参与者认为一期复位与尿失禁（61.2%）和勃起功能障碍发生率（75.8%）不明确相关，但狭窄发生率较低（73.0%）。在进行一期复位的受访者中，45.4%同时放置SP管，而54.6%不放置。虽然91%的人认为SP管不会增加骨盆内固定感染的风险，但31.6%的人报告称骨科医生在有SP管的情况下会改变其对骨盆骨折的处理方法。
大多数加拿大泌尿外科医生受访者——即使是那些在创伤中心执业的医生——每年处理的PFUI病例很少。受访者之间存在合理的共识，即一期复位优于延迟或即刻重建，但对于是否同时放置SP管存在分歧。SP管在创伤性泌尿系统损伤处理中的泌尿和骨科后果值得进一步研究。
