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Published on: January 7, 2019
[The association of pelvic injuries with urethral ruptures]
A Calabia de Diego1, J L Gutiérrez Baños, G López Rasines
1Departamento de Radiodiagnóstico, Hospital Universitario Valdecilla, Santander, Cantabria.
Insights
Pelvic trauma frequently causes posterior urethral injuries. Diagnosis requires careful evaluation, as initial signs like blood at the meatus can be absent, and catheterization may worsen damage.
Area of Science:
- Urology
- Trauma Surgery
- Radiology
Background:
- Pelvic trauma is a common cause of posterior urethral injuries.
- Clinical signs like blood at the urethral meatus or inability to void are not always present, necessitating further investigation.
- Attempting urethral catheterization can exacerbate existing injuries.
Purpose of the Study:
- To analyze the incidence and characteristics of urethral injuries in patients with pelvic trauma.
- To evaluate the relationship between pelvic fracture patterns and urethral injury severity.
- To assess diagnostic methodologies for urethral injuries.
Main Methods:
- Retrospective study of 565 pelvic trauma cases over five years.
- Classification of urethral injuries using the Colapinto and McCallum system.
- Analysis of injury diagnosis and outcomes.
Main Results:
- 60 urethral injuries (10.61%) were identified among 565 pelvic trauma patients.
- Injury grades correlated with pelvic ring fractures: Grade I with posterior ring, Grade II and III with anterior and posterior ring fractures.
- Deferred combined urethrography proved to be the most effective diagnostic method.
Conclusions:
- Urethral injuries are a significant complication of pelvic trauma.
- Accurate classification and imaging are crucial for effective management.
- Deferred combined urethrography is recommended for diagnosing urethral injuries in this patient population.
Introduction:
Pelvic trauma is associated in a high rate of patients with posterior urethral injuries. Blood at the urethral meatus or the inability to void are suspicious of urethral damage, but their absence do not exclude it. The attempt to pass a urethral catheter can worse a previous injury.
Method:
Retrospective study of 565 pelvic trauma along the last 5 years in the Hospital Valdecilla of Santander. We asses the urethral injury according Colapinto and McCallum classification and their relationship with the pelvic trauma, their outcome and diagnosis methodology.
Results:
There was 60 urethral injuries among 565 pelvic trauma (10.61%); 15 (25%) grade I were associated with trauma of the posterior ring of the pelvis; 17 (28.3%) grade II were associated in 12 cases with fractures of the anterior ring and in 5 cases with severe fractures of the posterior ring; 28 (46.66%) grade III were associated in 26 cases with fractures of the anterior ring and 2 fracture-luxation of the posterior one. Against the suggest of avoiding the attempt of passing a urethral catheter, nearly all patients had suffered and attempt before the urologist were asked for. The deferred combined urethrography was the best method of urethral evaluation.
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