Citation
Mishra K, Mahran A, Abboud B, Bukavina L, Elshafei A, Ray A 3rd, Fernstrum A, Abboud R, Elgammal M, Zhao LC, Gupta S. Validating the Martini Staging System for Rectourethral Fistula: A Meta-Analysis of Postoperative Outcomes. Urology. 2021 Jan; 147: 299-305. PMID 32916190
Abstract
To validate the Martini staging system for postoperative rectourethral fistula (RUF) utilizing data from previous studies to determine whether it can accurately predict postoperative success rate. A systematic search of peer-reviewed studies was conducted through January, 2020. The primary inclusion criteria for the studies were studies that evaluated outcomes based on the etiology of the fistula (ie, radiotherapy/ablation [RA] vs nonradiotherapy/ablation [NRA]). Martini RUF classification was utilized for the subgroup analysis. Out of 1948 papers, 7 studies with a total of 490 patients (251 in RA vs 239 NRA) were included in this study. Receiving RA increased the risk of permanent bowel diversion by 11.1 folds, eventual fistula recurrence by 9.1 folds, and post-op urinary incontinence (UI) by 2.6 folds. Similarly, compared to a Grade 0 fistula, a Grade I fistula increased the risk of permanent bowel diversion by 9.1 folds, fistula recurrence by 20 folds, and post-op UI by 2.7 folds. There were some valuable variables that were not captured by the Martini classification. Overall, the Martini classification system is efficacious in stratifying post-op complications from RUF repair based on the grade and etiology; however, it is limited in application. There is an opportunity for the development of more comprehensive staging systems in this domain.
Key Points
- Published in Urology in 2020.
- Indexed in PubMed as PMID 32916190.
- Mapped to Urethral Stricture & Urethroplasty, Prosthetics (AUS/IPP), Trauma & Fistula.
- Abstract available from PubMed and rendered as static text on this page.
Clinical Relevance
This article contributes to the urethral stricture and urethroplasty literature, with emphasis on staging, reconstruction, definitions of success, and long-term functional outcomes.