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| Emergency treatment of male blunt urethral trauma in China: Outcome of different methods in comparison with other countries |
Zhang Yumenga,Zhang Kaileb,Fu Qiangb( )
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a Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong, China
b Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai,China |
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Abstract Treatment of male urethral trauma is always a challenging problem. In China, as the incidence of urethral trauma keeps rising, more and more studies relating to this are being published. To compare the outcome of different emergency treatments in China and other countries, we searched Chinese and English literature about this topic in the past 16 years. A total of 167 studies involving 5314 patients were included, with 144 in Chinese and 23 in English. All studies were retrospective in nature. Based on the analyses, surgical methods include open realignment, endoscopic realignment and primary repair, and we summarized and compared the success rate and complications (mainly erectile dysfunction and incontinence) of each method. We found that realignment of posterior urethra has similar success rate in China and other countries, but the outcome of realignment of anterior urethra is variable. The reason remains unknown. While long abandoned in Western countries, primary repair of anterior urethra is still an option in China and has high success rate.
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Received: 20 September 2016
Published: 09 June 2018
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| Study | Country | Cases (n) | Success, n (%) | ED (n) | Incontinency (n) | | ESR of PUI | | Kim et al., 2013 [3] | US | 18 | 10 (55.6) | 7 | 3 | | Olapade-Olaopa et al., 2010 [4] | Nigeria | 10 | 5 (50.0) | - | - | | Sofer et al., 2010 [5] | Israel | 11 | 6 (54.5) | - | 6 | | Ku, 2002 [6] | Korea | 35 | 14 (40.0) | 4 | - | | Shrestha and Baidya, 2013 [7] | Nepal | 8 | 6 (75.0) | 1 | - | | Moudouni et al., 2001 [8] | France | 27 | 15 (55.6) | 4 | - | | Leddy et al., 2012 [9] | US | 18 | 4 (22.2) | 4 | - | | Healy et al., 2007 [10] | Ireland | 8 | 6 (75.0) | 3 | - | | Salehipour et al., 2005 [11] | Iran | 25 | 19 (76.0) | 4 | - | | Mouraviev et al., 2005 [12] | US | 57 | 29 (50.9) | 19 | 10 | | Boulma et al., 2013 [13] | Tunisia | 20 | 13 (65.0) | 1 | - | | Abdalla et al., 2015 [14] | Egypt | 16 | 0 (0) | 2 | - | | Hadjizacharia et al., 2008 [15] | US | 14 | 12 (85.7) | - | - | | Johnsen et al., 2015 [16] | US | 27 | 10 (37.0) | 18 | 2 | | Abdelsalam et al., 2013 [17] | Egypt | 41 | 18 (43.9) | 13 | 3 | | Moudouni et al., 2001 [18] | France | 29 | 17 (58.6) | 4 | - | | El Kady et al., 2014 [19] | Egypt | 15 | 6 (40.0) | - | - | | Lee et al., 2016 [20] | Korea | 12 | 6 (50.0) | - | - | | ESR of AUI | | Seo et al., 2012 [21] | Korea | 51 | 31 (60.8) | - | - | | Ku et al., 2002 [22] | Korea | 65 | 53 (81.5) | 2 | - | | Elgammal, 2009 [23] | Brazil | 22 | 4 (18.2) | - | - | | Park and McAninch, 2004 [24] | US | 6 | 0 (0.0) | - | - | | Primary repair of AUI | | Gong et al., 2012 [25] | Korea | 17 | 15 (88.2) | 3 | - |
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| Number of studies | Total cases, n | Success, n(%) | ED, n(%) | Incontinency, n (%) | Complication rate (%)a | | OR of PUI | 48 | 2582 | 1498 (58.0) | 179 (6.9) | 47 (1.8) | 8.8 | | ESR of PUI | 24 | 574 | 327 (57.0) | 25 (4.4) | 5 (0.9) | 5.2 | | ESR of AUI | 49 | 1015 | 579 (57.0) | 13 (1.3) | 0 | 1.3 | | Primary open repair of AUI | 23 | 591 | 506 (85.6) | 12 (2.0) | 0 | 2.3a |
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Success rate distribution of studies about primary repair of AUI in Chinese literature (A), ESR of AUI in Chinese literature (B), and ESR of AUI in English literature (C). AUI, anterior urethral injury; ESR, endoscopic realignment.
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Management flowchart of emergency traumatic urethral injury (blunt trauma only). (A) Modified from 2010 EAU guideline; (B) The most common practice in China. RUG, retrograde urethrogram; ESR: endoscopic realignment; VS, vital signs; UI, urethral injuries.
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Success rate distribution of studies about OR of PUI in Chinese literature (A), ESR of PUI in Chinese literature (B), and ESR of PUI in English literature (C). ESR, endoscopic realignment; OR, open realignment; PUI, anterior urethral injury.
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| Study | Treatment | Patients, n | Success, n (%) | Complication, n | | Zhang et al. 2004 [61] | PR | 14 | 12 (85.7) | 1 (infection) | | ESR | 8 | 6 (75.0) | 0 | | Ren et al. 2008 [70] | PR | 8 | 8 (100) | 0 | | ESR | 20 | 0 (0) | 0 | | Zhang et al. 2012 [65] | PR | 13 | 12 (92.3) | 2 (infection) | | ESR | 20 | 14 (70.0) | 0 | | Chen et al. 2008 [71] | PR | 15 | 5 (33.3) | 0 | | ESR | 15 | 13 (86.7) | 0 | | Yu et al. 2006 [72] | PR | 26 | 24 (92.3) | 0 | | ESR | 32 | 23 (71.9) | 0 |
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