SynthesisWorld journal of urology2025
A systematic review and meta-analysis of surgical approaches in pelvic fracture-associated urethral injury: primary endoscopic realignment versus delayed urethroplasty.
Synthesis in World journal of urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
4 authors.
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Abstract
backgroundPelvic fracture urethral injury (PFUI) can produce considerable morbidity, including urethral stricture, urinary incontinence, and erectile dysfunction. Optimal management of PFUI is unclear, however, the current gold standard is placement of a suprapubic cystostomy with delayed urethroplasty (SCDU) performed several months later. Another option is primary realignment (PR) with urethral catheter. Through a systematic review and meta-analysis, we aimed to compare the outcomes of PR and SCDU in patients with PFUI.
methodsA systematic search across databases (PubMed, ScienceDirect, Web of Science and Cochrane Library) was conducted without time or language limitations. Both medical subject heading and free text terms as well as variations of root word were searched. Randomised controlled trials (RCTs), nonrandomised comparative studies and single-arm case series were included. Data were narratively synthesised considering methodological and clinical heterogeneity. The risk of bias of each included study was assessed.
resultsFrom 1,780 identified articles, 11 studies encompassing 412 PR and 357 SCDU met our eligibility criteria. All studies were non-randomized comparative studies. In general, included studies were of moderately quality. Follow-up durations ranged from 1 to 264 months. Meta-analysis demonstrated that PR and SCDU had comparable rates of stricture (OR: 1.23, [95%CI 0.24-6.37], p = 0.80), urinary incontinence (OR: 1.02, [95%CI 0.59-1.79], p = 0.94), and ED (OR: 0.97, [95%CI 0.64-1.46], p = 0.88).
conclusionTo conclude, this study found that primary realignment did not yield superior outcomes in terms of stricture formation, urinary incontinence, and rates of erectile dysfunction compared to SCDU. It is noteworthy that the predominant inclusion of non-randomized retrospective studies in this analysis introduces a potential for bias. Additional high-quality research, particularly prospective studies and randomized controlled trials are needed to validate these findings.
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