Incidence and immediate management of genitourinary injuries in pelvic and acetabular trauma: a 10‐year retrospective study

Bhatt, Nikita; Merchant, Rajiv; Davis, Niall F.; Leonard, Michael; OʼDaly, Brendan J.; Manecksha, Rustom P.; Quinlan, John

doi:10.1111/bju.14161

Cited by 15 publications

(23 citation statements)

References 21 publications

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“…and some cases were inappropriately operatively explored as a result [7]. Another study assessed patients with traumatic pelvic and acetabular fractures and found that only 47% of patients with pelvic or acetabular fractures that also had hematuria had a formal urologic evaluation on initial presentation [8]. ese findings emphasize that although guidelines are in place for appropriate bladder imaging, they are not always being followed.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Bladder Ruptures: A Ten-Year Review at a Level 1 Trauma Center

Barnard

Overholt

Hajiran

et al. 2019

Advances in Urology

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Bladder rupture occurs in only 1.6% of blunt abdominopelvic trauma cases. Although rare, bladder rupture can result in significant morbidity if undiagnosed or inappropriately managed. AUA Urotrauma Guidelines suggest that urethral catheter drainage is a standard of care for both extraperitoneal and intraperitoneal bladder rupture regardless of the need for surgical repair. However, no specific guidance is given regarding the length of catheterization. e present study seeks to summarize contemporary management of bladder trauma at our tertiary care center, assess the impact of length of catheterization on bladder injuries and complications, and develop a protocol for management of bladder injuries from time of injury to catheter removal. A retrospective review was performed on 34,413 blunt trauma cases to identify traumatic bladder ruptures over the past 10 years (January 2008-January 2018) at our tertiary care facility. Patient data were collected including age, gender, BMI, mechanism of injury, and type of injury. e primary treatment modality (surgical repair vs. catheter drainage only), length of catheterization, and post-injury complications were also assessed. Review of our institutional trauma database identified 44 patients with bladder trauma. Mean age was 41 years, mean BMI was 24.8 kg/m 2 , 95% were Caucasian, and 55% were female. Motor vehicle collision (MVC) was the most common mechanism, representing 45% of total injuries. Other mechanisms included falls (20%) and allterrain vehicle (ATV) accidents (13.6%). 31 patients had extraperitoneal injury, and 13 were intraperitoneal. Pelvic fractures were present in 93%, and 39% had additional solid organ injuries. Formal cystogram was performed in 59% on presentation, and mean time to cystogram was 4 hours. Gross hematuria was noted in 95% of cases. Operative management was performed for all intraperitoneal injuries and 35.5% of extraperitoneal cases. Bladder closure in operative cases was typically performed in 2 layers with absorbable suture in a running fashion. e intraperitoneal and extraperitoneal injuries managed operatively were compared, and length of catheterization (28 d vs. 22 d, p � 0.46), time from injury to normal fluorocystogram (19.8 d vs. 20.7 d, p � 0.80), and time from injury to repair (4.3 vs. 60.5 h, p � 0.23) were not statistically different between cohorts. Patients whose catheter remained in place for greater than 14 days had prolonged time to initial cystogram (26.6 d vs. 11.5 d) compared with those whose foley catheter was removed within 14 days. e complication rate was 21% for catheters left more than 14 days while patients whose catheter remained less than 14 days experienced no complications. e present study provides a 10-year retrospective review characterizing the presentation, management, and follow-up of bladder trauma patients at our level 1 trauma center. Based on our findings, we have developed an institutional protocol which now includes recommendations regarding length of catheterization after traumatic bladder rupture. B...

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Section: Discussionmentioning

confidence: 99%

Traumatic Bladder Ruptures: A Ten-Year Review at a Level 1 Trauma Center

Barnard

Overholt

Hajiran

et al. 2019

Advances in Urology

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“…Minor fractures rarely cause urethral injury, and most PFUIs result from massive blunt shearing force, and pelvic fractures with disruption of the pelvic ring . Although earlier data suggest that the incidence of PFUI is 10–25% of males with pelvic fracture, later data showed a much lower incidence (1.4–2%) . The male urethra can be subdivided into the anterior urethra and posterior urethra.…”

Section: Pathophysiology and Mechanism Of Pfuimentioning

confidence: 99%

“…2,12 Although earlier data suggest that the incidence of PFUI is 10-25% of males with pelvic fracture, later data showed a much lower incidence (1.4-2%). 4,10,13 The male urethra can be subdivided into the anterior urethra and posterior urethra. The anterior urethra consists of the fossa navicularis, penile urethra and bulbar urethra, whereas the posterior urethra consists of the membranous urethra and prostatic urethra.…”

Section: Introductionmentioning

confidence: 99%

Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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Pelvic fractures from high‐energy blunt force trauma can cause injury to the posterior urethra, known as pelvic fracture urethral injury, which is most commonly associated with unstable pelvic fractures. Pelvic fracture urethral injury should be suspected if a patient with pelvic trauma has blood at the meatus and/or difficulty voiding, and retrograde urethrography should be carried out if the patient is stable. Once urethral injury is confirmed, urinary drainage should be established promptly by placement of a suprapubic tube or primary realignment of the urethra over a urethral catheter. Although pelvic fracture urethral injury is accompanied by subsequent urethral stenosis in a high rate and it has been believed that primary realignment can reduce the risk of developing urethra stenosis, it also has a risk of complicating stenosis and its clinical significance remains controversial. Once inflammation and fibrosis have stabilized (generally at least 3 months after the trauma), the optimal management for the resulting urethral stenosis is delayed urethroplasty. Delayed urethroplasty can be carried out via a perineal approach using four ancillary techniques in steps (bulbar urethral mobilization, corporal separation, inferior pubectomy and urethral rerouting). Although pelvic trauma can impair continence mechanisms, the continence after repair of pelvic fracture urethral injury is reportedly adequate. Because erectile dysfunction is frequently encountered after pelvic fracture urethral injury and most patients are young with a significant life expectancy, its appropriate management can greatly improve quality of life. In the present article, the key factors in the management of pelvic fracture urethral injury are reviewed and current topics are summarized.

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“…Therefore, with pelvic ring fractures (PRFs) these structures are injured in approximately 5% of patients [2]. lnjuries to the bladder and urethra are referred to as lower urinary tract injuries (LUTIs) and typically occur after high-energy trauma like road traffic accidents and after falls from a significant height [3,4]. Associations between PRFs and LUTIs after high energy trauma are through direct mechanisms (e.g.…”

mentioning

confidence: 99%

“…Conversely, limitations of the study are that the extent, grade, management and outcomes of each LUTI were not measured or analyzed in detail. Therefore, it is difficult to clearly determine whether more unstable PRFs resulted in higher grades of bladder and urethral injuries [4]. In addition, it is difficult to make definitive conclusions based on the relatively small numbers in the subgroup analysis.…”

mentioning

confidence: 99%