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An American Association for the Surgery of Trauma (AAST) prospective multi-center research protocol: outcomes of urethral realignment versus suprapubic cystostomy after pelvic fracture urethral injury

  
@article{TAU17423,
	author = {Rachel A. Moses and John Patrick Selph and Bryan B. Voelzke and Joshua Piotrowski and Jairam R. Eswara and Bradley A. Erickson and Shubham Gupta and Roger R. Dmochowski and Niels V. Johnsen and Anand Shridharani and Sarah D. Blaschko and Sean P. Elliott and Ian Schwartz and Catherine R. Harris and Kristy Borawski and Bradley D. Figler and E. Charles Osterberg III and Frank N. Burks and William Bihrle III and Brandi Miller and Richard A. Santucci and Benjamin N. Breyer and Brian Flynn and Ty Higuchi and Fernando J. Kim and Joshua A. Broghammer and Angela P. Presson and Jeremy B. Myers and from the Trauma and Urologic Reconstruct Network of Surgeons (TURNS)},
	title = {An American Association for the Surgery of Trauma (AAST) prospective multi-center research protocol: outcomes of urethral realignment versus suprapubic cystostomy after pelvic fracture urethral injury},
	journal = {Translational Andrology and Urology},
	volume = {7},
	number = {4},
	year = {2017},
	keywords = {},
	abstract = {Background: Pelvic fracture urethral injuries (PFUI) occur in up to 10% of pelvic fractures. It remains controversial whether initial primary urethral realignment (PR) after PFUI decreases the incidence of urethral obstruction and the need for subsequent urethral procedures. We present methodology for a prospective cohort study analyzing the outcomes of PR versus suprapubic cystostomy tube (SPT) after PFUI. 
Methods: A prospective cohort trial was designed to compare outcomes between PR (group 1) and SPT placement (group 2). Centers are assigned to a group upon entry into the study. All patients will undergo retrograde attempted catheter placement; if this fails a cystoscopy exam is done to confirm a complete urethral disruption and attempt at gentle retrograde catheter placement. If catheter placement fails, group 1 will undergo urethral realignment and group 2 will undergo SPT. The primary outcome measure will be the rate of urethral obstruction preventing atraumatic passage of a flexible cystoscope. Secondary outcome measures include: subsequent urethral interventions, post-injury complications, urethroplasty complexity, erectile dysfunction (ED) and urinary incontinence rates. 
Results: Prior studies demonstrate PR is associated with a 15% to 50% reduction in urethral obstruction. Ninety-six men (48 per treatment group) are required to detect a 15% treatment effect (80% power, 0.05 significance level, 20% loss to follow up/death rate). Busy trauma centers treat complete PFUI approximately 1–6 times per year, thus our goal is to recruit 25 trauma centers and enroll patients for 3 years with a goal of 100 or more total patients with complete urethral disruption. 
Conclusions: The proposed prospective multi-institutional cohort study should determine the utility of acute urethral realignment after PFUI.},
	issn = {2223-4691},	url = {http://tau.amegroups.com/article/view/17423}
}