Urogenital disorders after pelvic ring injuries

Abstract

IntroductionThe close anatomical relationship between the skeletal and connective systems of the pelvis, neurological, and vascular structures and pelvic organs are predisposing factors for structural and functional damages of the urogenital system.Materials and methodsWe performed PUBMED and MEDLINE search using terms “pelvic ring trauma/disruption, bladder injury, urethral injury, sexual dysfunction”.ResultsThe probability of damage of the pelvic organs increases along with the degree of disturbance of integrity of the pelvic ring. The most important risk factor of urogenital injuries is the rupture of the symphyseal joint. Patients with lesions of the urogenital system have a higher risk of mortality compared with patients without lesions of the urogenital system. Sexual dysfunctions along with urinary incontinence are a common consequence of the pelvic fracture in men and women.ConclusionsInjuries of the urogenital organs during pelvic ring fractures have an important negative prognostic value in terms of morbidity and quality of life. A prerequisite for a successful therapeutic outcome in case of pelvic fractures with disturbance of pelvic ring integrity is cooperation of orthopedists and urologists, with possible early diagnosis and treatment of injuries of the urogenital organs.

The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures

“…DRE to check for a high-riding prostate in males is thought to be obsolete as this assessment has been found to be unreliable for evaluation of urethral disruption in males ( 36 ). Blood at the external urethral meatus, gross haematuria, or in females- vaginal lacerations or bleeding, increases suspicion for bladder or urethral injuries and a suprapubic catheter (SPC) can be inserted in the operating theatre, to drain the bladder ( 1 , 37 ). The associated soft tissue injuries (STI) are classified according to the Faringer or the Jones-Powell classification systems ( Table 1 ).…”

“…This is where co-ordination of sub-specialty individualised and needs based care becomes crucial to good patient outcomes, and this process should be adapted according to the patient's injuries and needs. These include; reconstructive procedures to provide soft tissue coverage including skin grafting and flaps, formal bowel diversion surgery (stoma for a colostomy) ( 15 , 47 – 50 ), assessment of urethral injury (cystography and insertion of an IDC for urethral realignment, often definitive repair is delayed) ( 37 ), continued wound management with washouts and surgical debridement's of wounds and wound management using VAC dressings and instillation VAC therapy (VERAFLO) as required ( 2 , 46 , 51 , 52 ).…”

Spontaneous Urethral Laceration in a Patient Experiencing Acute Ulcerative Colitis Flare

“…Urethral injuries are commonly secondary to well-defined traumatic events such as blunt trauma, penetrating injuries, or iatrogenic injuries including traumatic instrumentation [1]. The overall incidence of trauma-related pelvic injury is thought to be 5-10% when associated with a pelvic fracture making this type of injury not uncommon [2].…”

Pelvic post-traumatic asymmetry

“…There are other symptoms associated with pelvic deformity, such as leg-length discrepancy, aesthetic defects due to bony prominences, posture problems (sitting and standing imbalance) and sexual or urological disorders. 1 - 3 , 6 …”