Lower urinary tract trauma

Twenty-eight patients with lower urinary tract injuries were reviewed at Hôtel-Dieu de Montréal. Eighteen involved the urethra and ten involved the bladder. Pelvic rami fractures are the main cause of bladder rupture, including almost all cases of extraperitoneal bladder rupture. Pelvic fractures are also the main cause of posterior and bulbo-menbranous urethra rupture. Endoscopy and indwelling catheter insertions follow in importance. Rupture of the bladder can be either extraperitoneal (80%) or intraperitoneal (20%). Ruptures of the urethra involve mainly the posterior and bulbo-membranous segments of the urethra. Post-traumatic strictures nevertheless affect the anterior segment more commonly. In all suspected cases of injury involving the lower urinary tract, retrograde urethrography should be done first, followed by retrograde cystography if indicated. A good knowledge of the relationship of the anatomic compartments is essential to the assessment of communicating injury.