Posterior urethral injuries after pelvic fracture

Area of Science:

• Urology
• Trauma Surgery
• Radiology

Background:

• Posterior urethral rupture is a severe complication of anterior pelvic arch fractures.
• Traditional understanding attributes these injuries to the prostate apex with contrast extravasation above the urogenital diaphragm.

Purpose of the Study:

• To evaluate posterior urethral injuries using the Colapinto and McCallum classification.
• To determine the actual patterns of posterior urethral injury in patients with pelvic fractures.

Main Methods:

• Retrospective review of 18 patients with proven posterior urethral injuries.
• Retrograde urethrography performed before urethral catheterization in all cases.
• Classification of injuries based on the Colapinto and McCallum system.

Main Results:

• The traditional concept of posterior urethral injury was found to be unusual.
• 12 out of 18 patients (67%) had injuries extending both above and below the urogenital diaphragm.
• Only 3 out of 18 patients (17%) presented with the classical injury pattern.

Conclusions:

• Posterior urethral injuries associated with pelvic fractures often have complex patterns extending beyond the prostate apex.
• The Colapinto and McCallum classification provides a more accurate framework for understanding these injuries.
• Urethrography is crucial for diagnosing the extent of posterior urethral disruption.