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Treatment Discrepancy for Pelvic Fracture Patients With Urethral Injuries

A Survey of Orthopaedic and Urologic Surgeons

Johnsen, Niels V. MD*; Firoozabadi, Reza MD, MA; Voelzke, Bryan B. MD

doi: 10.1097/BOT.0000000000001482
Opinions and Surveys
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Objectives: In patients with traumatic pelvic fracture urethral injuries (PFUI), the interaction between urethral management and orthopaedic decision making remains unknown. We aimed to survey orthopaedic and urologic surgeons to assess interdisciplinary interactions in the management of PFUI.

Methods: An anonymous cross-sectional survey of members of the Orthopaedic Trauma Association (OTA) and the Society of Genitourinary Reconstructive Surgeons (GURS) was conducted between September 2017 and August 2018. Participants were queried regarding the impact of urethral injuries and their management on orthopaedic operative decision making.

Results: Fifty-three GURS and 64 OTA members responded (17% response rate). For urethral injury management, 73% of OTA respondents preferred that suprapubic tubes (SPTs) were not placed for urethral injury management, whereas 43% of GURS respondents preferred SPTs (P = 0.08). Ninety-two percent of OTA respondents stated that SPTs increase hardware infection risks in patients undergoing pelvic open reduction with internal fixation (ORIF), whereas only 8% of GURS respondents agreed (P < 0.01). Although 66% of GURS respondents reported not considering the operative plans of orthopaedics when determining urethral management, 75% of OTA respondents reported that they were less inclined to proceed with ORIF, and 70% would perform external fixation in the setting of an SPT, despite 78% believing that this resulted in an inferior outcome for the patient.

Conclusions: There is discordance between urologists and orthopaedists as to the optimal management of PFUI patients, with significant disagreement regarding the infectious risks of SPT in the setting of ORIF. Improved data and interdisciplinary dialogue are required to maximize patient outcomes.

Level of Evidence: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

*Department of Urology and Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; and

Departments of Orthopaedics, and

Urology, University of Washington, Seattle, WA.

Reprints: Reza Firoozabadi, MD, MA, Harborview Medical Center, Box 359868, 325 Ninth Avenue, Seattle, WA 98104 (e-mail: Rezaf2@uw.edu).

The authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com).

Accepted March 06, 2019

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