Urethral injuries in female subjects following pelvic fractures

Pelvic fractures resulting from high speed motor vehicle and/or pedestrian-motor vehicle accidents commonly coexist with urethral injuries in the male patient. A review of 130 female patients with pelvic fractures managed at our institution revealed coexisting urethral injuries in 6 (4.6%). Partial urethral disruptions accounted for the majority of morbidity with early removal of the Foley catheter resulting in urinary extravasation, voiding difficulties and vulvar edema. In 3 patients the injury was misdiagnosed, 2 of whom had life-threatening sepsis with necrotizing fascitis as a consequence. Blood at the vaginal introitus was noted in more than 80% of our patients. However, only half of them had a careful vaginal inspection. If this pertinent portion of the physical examination had been performed more than two-thirds of our patients could have been correctly diagnosed. The need for meticulous vaginal examination when blood is located at the vaginal introitus, and the need for careful cystoscopic and/or radiographic evaluations in the female patient with voiding difficulties and/or vulvar edema in the acute post-traumatic phase are stressed.