MP25-20 SURVEY OF UROLOGIC AND ORTHOPEDIC SURGEON VIEWS REGARDING THE MANAGEMENT OF PATIENTS WITH PELVIC FRACTURE URETHRAL INJURIES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II1 Apr 2018MP25-20 SURVEY OF UROLOGIC AND ORTHOPEDIC SURGEON VIEWS REGARDING THE MANAGEMENT OF PATIENTS WITH PELVIC FRACTURE URETHRAL INJURIES Niels Johnsen, Reza Firoozabadi, and Bryan Voelzke Niels JohnsenNiels Johnsen More articles by this author , Reza FiroozabadiReza Firoozabadi More articles by this author , and Bryan VoelzkeBryan Voelzke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.857AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Significant controversy exists regarding the management of pelvic fracture urethral injuries (PFUI). While much of the literature focuses on urologic outcomes, the impact of urethral management strategies on orthopedic treatment decisions remains unknown. We surveyed orthopedic and urologic surgeons to assess practice patterns and multi-disciplinary interactions following PFUI. METHODS Anonymous online questionnaires were sent to active clinical members of the Orthopedic Trauma Association (OTA) and the Society of Genitourinary Reconstructive Surgeons (GURS). Participants were queried regarding clinical practice patterns and decision-making in the treatment of PFUI patients. Responses were collected between 9/1/17 and 11/7/17 and aggregated in an online REDCap database. RESULTS 30 OTA and 48 GURS members responded to the survey (response rate of 9% and 17%, respectively). Except for 3 GURS members, all respondents managed PFUI patients annually, with the majority managing between 1 and 10 PFUI per year (69% of GURS respondents vs 93% of OTA respondents). While the preferred management of urethral injuries by GURS respondents was evenly divided (46% suprapubic tube [SPT] and 54% early endoscopic realignment [EER]), 87% of OTA respondents preferred EER. 92% of GURS respondents did not believe that SPT increased the risk of infection following pelvic internal fixation, while 97% of OTA respondents did. 71% of GURS respondents reported that the operative plan of orthopedics was not considered in their choice of EER vs SPT. Conversely, 83% of OTA respondents stated that the presence of a urethral injury affects orthopedic management, with 97% stating that a SPT in particular affects management decision-making. In particular, there was discordance regarding the perceived impact of SPT on choice of internal fixation, with 54% of GURS and 76% of OTA respondents stating that orthopedic surgeons were more inclined to perform external fixation if a SPT was present. Furthermore, 86% of OTA respondents stated that external fixation results in an inferior patient outcome CONCLUSIONS There exists a significant disconnect between urologists and orthopedists regarding the preferred urologic management of PFUI patients and the theoretical risks associated with hardware infection in patients with a SPT. Higher quality data are needed to better elucidate the true infectious risks associated with SPT and improved inter-service dialogue is necessary to maximize patient outcomes. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e334-e335 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Niels Johnsen More articles by this author Reza Firoozabadi More articles by this author Bryan Voelzke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...