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Urethral injury secondary to pelvic fracture: anatomical and functional classification
M Al Rifaei1, N I Eid, A Al Rifaei
1Department of Urology, Faculty of Medicine, University of Alexandria, Egypt.
Insights
A new classification for urethral injuries from pelvic fractures was developed. This system categorizes injuries anatomically and functionally, aiding in treatment and medicolegal evaluations.
Area of Science:
- Urology
- Trauma Surgery
- Anatomy
Background:
- Pelvic fractures frequently cause urethral injuries.
- Existing classifications lack comprehensive anatomical and functional detail.
- Accurate classification is crucial for effective management.
Purpose of the Study:
- To propose a novel, detailed classification system for urethral injuries resulting from pelvic fractures.
- To integrate both anatomical location and functional impact into the classification.
- To improve diagnostic accuracy and guide therapeutic strategies.
Main Methods:
- Retrospective review of 56 male patients (20 children, 36 adults) with pelvic fracture-associated urethral injuries.
- Evaluation included clinical examination, retrograde urethrograms, operative findings (emergency and reconstruction), and follow-up.
- Combined retrograde urethrography and suprapubic cystography were utilized.
Main Results:
- A new 5-type classification system for urethral injury secondary to pelvic fracture was developed.
- Types include prostatic injury (avulsion/rupture), membranous urethra stretching, prostatomembranous junction rupture, bulbomembranous urethra rupture, and combined injuries.
- The classification addresses injuries at various levels and involves the sphincteric mechanism.
Conclusions:
- The proposed classification encompasses all urethral injury types associated with pelvic fractures.
- It emphasizes the evaluation of the urethral sphincteric mechanism.
- This system is essential for guiding therapeutic interventions and medicolegal assessments.
Objective:
To develop a new functional and anatomical classification of urethral injury secondary to pelvic fracture.
Material And Methods:
Fifty-six male patients (20 children, 36 adults) with urethral injuries secondary to pelvis fracture were evaluated. Clinical examination, retrograde urethrogram immediately after the accident, operative findings in the emergency state, subsequent combined retrograde urethrography and suprapubic cystography, operative findings during urethral reconstruction and postoperative follow-up were critically reviewed retrospectively.
Results:
A new classification of urethral injury secondary to pelvic fracture is proposed as a result of our findings: Type 1. Injury to the prostate; 1a. Proximal avulsion of the prostate; 1b. Incomplete or complete trans-prostatic rupture. Type 2. Stretching of the membranous urethra. Type 3. Incomplete or complete pure rupture of the prostatomembranous junction, supradiaphragmatic. Type 4. Incomplete or complete rupture of the bulbomembranous urethra, infradiaphragmatic. Type 5. Variable combined urethral injuries affecting more than one level of the urethra, prostatic and membranous or prostatomembranous and bulbomembranous, injury to proximal sphincteric mechanism combined with prostatic and/or membranous urethral injury.
Conclusions:
This anatomical and functional classification includes all types of urethral injuries secondary to pelvic fracture; moreover, it directs the attention towards evaluation of the urethral sphincteric mechanism, which is essential for the therapeutic and medicolegal aspects.