Female urethral injuries associated with pelvic fracture: a systematic review of the literature

Objectives To systematically review the literature of female urethral injuries associated with pelvic fracture and determine optimal management of this rare injury. Materials and Methods Using Meta-analysis Of Observational Studies in Epidemiology criteria, we searched Cochrane, Pubmed and OVID databases for all articles available before June 30, 2016 using the terms “female pelvic fracture urethroplasty,” “female urethral distraction,” “female pelvic fracture urethral injury,” “female pelvic fracture urethra girls.” Two reviewers (CF, DP) independently reviewed the titles, abstracts, and articles in duplicate. Results We identified 162 individual articles from the databases. Fifty-one articles met our criteria for full review. There were 158 female patients with urethral trauma. Of these injuries, 83 (53%) were managed with immediate repair, with 17/83 (20%) via primary alignment and 66/83 (80%) via anastomotic repair. The remaining 75/158 (47%) were managed with delayed repair. Rates of urethral stenosis and fistula were highest after primary alignment. Urethral integrity appears to be similar following both primary anastomosis and delayed repair; however, patients experienced significantly more incontinence and vaginal stenosis following delayed repair. Those patients who underwent delayed urethral repair were more likely to undergo more extensive reconstructive surgery than those who underwent primary repair. Conclusions The optimal management of female urethral distraction defects is based on very low quality literature. Based on our review of the available literature, primary anastomotic repair of a female urethral distraction defect via a vaginal approach as soon as the patient is hemodynamically stable appears optimal. This article is protected by copyright. All rights reserved.