Urological complications of pelvic fractures
Authors:
Jana Hlaváčová 1; Milan Hora 1; Tomáš Pavelka 2; Viktor Eret 1; Jiří Ferda 3; Jan Bulka 4
Authors‘ workplace:
Urologická klinika LF UK a FN, Plzeň
1; Klinika ortopedie a traumatologie
pohybového ústrojí LF UK a FN, Plzeň
2; Radiodiagnostická klinika LF UK a FN
Plzeň
3; Radiodiagnostické oddělení LF UK a FN
Plzeň
4
Published in:
Ces Urol 2011; 15(1): 35-44
Category:
Original article
Overview
Aim:
Summarized our own experience and results of urological complications of pelvic fractures.
Methods:
In the period between January 1998 and December 2009 we treated 38 patients for strana 36 Ces Urol 2011; 15(1): 35–44 severe urinary tract injury following pelvic trauma.
Results:
The mean age was 40 years (range 21–71). The urinary bladder rupture (UBR) was diagnosed in 21 patients. Two men had concomitant posterior urethral trauma. After the UBR was diagnosed, all UBRs were treated by operative revision and urinary bladder suture within 24 hours. The posterior urethral trauma (PUT) was diagnosed in 19 patients. We performed acute revision and primary urethral realignment in nine patients. Epicystostomy was introduced in nine patients, one patient was primary introduced a urinary catheter. We indicated posterior resection urethroplasty after three months in five patients. In 13 men with partial rupture of the urethra was not needed further treatment. Erectile dysfunction appeared in seven men.
Conclusion:
The UBR does not cause neither a diagnostic nor a curative problem. In suspicion of PUT a retrograde urethrography is necessary before instrumentation. After that we perform introduction of epicystostomy or primary realignment. The PUT is followed by posterior resection urethroplasty after 12 weeks.
Key words:
pelvic fracture, urethral trauma, retrograde urethrography, bladder rupture, urethral stricture.
Sources
1. Koraitim MM. Pelvic fracture urethral injurie: the unresolved controversy. J Urol 1999; 161:
1433–1441.
2. Machtens S, Gansslen A, Pohlemann T, Stref CG. Erectile dysfunction in relation to traumatic
pelvic injurie or pelvic fractures. BJU Int 2001; 87: 441–448.
3. Hemal AK, Dorairajan LN, Gusta NP. Posttraumatic complete and partial loss of uretra with
pelvic fracture in girls: an appraisal of management. J Urol 2000; 163: 282–287.
4. Brandes S, Borelli J jr. Pelvic fracture and associated urological injurie. World J Surg 2001; 25:
1578–1587.
5. Michek J, Zelníček P, Vrastyák J, et al. Existuje pánevní kompertment? Naše zkušenosti. Rozhl
Chir 2002; 79: 568–570.
6. Pavelka T, Dzupa V, Rysavý M, et al. Pelvic ring injury. Acta Chir Orthop Traumatol Czech
2006; 73(6): 405–413.
7. Goldman SM, Sander CM, Corriere JN. Jr, McGuire EJ. Blunt urethral trauma: a unified,
anatomical machanical classification. J Urol 1997; 157: 85–89.
8. McAninch JW. Injuries to the Genitourinary Tract. In: Tanangho EA, McAninch JW. Smith’s
General Urology, 14 ed. Prentice Hall International 1995: 308–326.
9. Carroll PR, McAninch JW. Major Bladder Trauma: Mechanisms of Injury and a Unified
Method of Diagnosis and Repair. J Urol 1984; 132: 254–257.
10. Sagalowsky AI, Peters PC. Genitourinary trauma. In: Walsh PC, Retik AB, Vaughan ED. Jr.,
Sein AJ. Campbell’s urology 7 th ed. USA: WB Saunders Copany; 1998: 3058–3120.
11. Pavelka T, Dzupa V, Stulík J, et al. Our results of surgical management of unstable pelvic ring
injuries. Acta Chir Orthop Traumatol Czech 2007; 74(1): 19–28.
12. Pavelka T, Houček, P, Hora M, Hlaváčová J, Linhart M. Urologické poranění při zlomeninách
pánevního kruhu. Acta Chir Orthop Traumatol Czech 2010; 77(1): 18–23.
13. Andrich DE, Mundy AR. The nature of urethral injury in cases of pelvic fracture uretrhral
trauma. J Urol 2001; 165: 1492–1495; editorial comments – Corriere JN. Jr, Blandy J, Koraitim
MM. 1494–1495.
14. Fiala R, Záťura F, Reif R. Léčba potraumatických distrakčních defektů mužské močové trubice.
Úraz Chir 2001; 9: 6–12.
15. Morey AF, Bruce JE, McAninch JW. Reconstruction of Traumatic Posterior Urethral Strictures:
Outcome Analysis in 82 Pacients, AUA, Abstracts on dics, Annual Convention, Orlando
1996.
16. Al-Rifaei MA, Al-Rifaei A. Management of postoperative obstruction after bulboprostatic
anastomotic uretrhroplasty for membranous uretrhral defects secondary to pelvic fracture.
Scand J Urol Nephrol 2001; 35: 491–496.
17. Koraitim MM, Marzouk ME, Orabi SS. Risk Factors and Mechanism of Urethral Injury in
Pelvic Fractures. J Urol 1996; 77-B: 876–880.
18. Yerasimides J, Roberts CS. Pelvic Fractures and Genitourinary Injuries. Curr Orthop 2005;
19: 354–361.
19. Ziran BH, Chamberlin E, Shuler FD, Shah M. Delay and Difficulties in the Diagnosis of
Lower Urologic Injuries in the Context of the Pelvic Fractures. J Trauma 2005; 58: 533–537.
20. Podesta ML, Jordan GH. Pelvic fracture urethral injurie in viros. J Urol 2001; 165: 1660–1665,
editorial comment: Patel U. 1665.
21. Hora M, Zeman J, Kastner J, et. al. Urologické komplikace úrazů pánve. Rozhl Chir 2003; 82:
129–137.
22. Dzupa V, Ryantová V, Skála-Rosenbaum J, et al. Infectious complications of surgically treatment
pelvic fractures. Acta Chir Orthop Traumatol Czech 2008; 75(4): 293–296.
23. Geavlete P, Georgrscu D, Cauni V, et al. Endourogical treatment in blunt urethral trauma
EUVJ 4/1999(6); video 3; comments: Puppo P.
24. Ennemoser O, Colleselli K, Poisel S, et al. Posttraumatic posterior urethral stricture repair:
anatomy, surgical approach and long term results. J Urol 1997; 157: 499–505.
25. Mouraviev VB, Coburn M, Santucci RA. The treatment of posterior urethral disruption associated
with pelvic fractures: comparative experience of early realignment versus delayed urethroplasty.
J Urol 2005; 173(3): 837-876.
26. Grill R, Mašková V, Džupa V, et al. Urologické a sexuální poruchy po závažném poranění
pánve. Ces Urol 2007; 11(2): 112–114.
27. Montorsi F, Guazzoni G, Strambi LF, et al. Recovery of spontaneous erectile function after
nerve-sparing radical retropubic prostetectomy with and without early intracavernous injestions
of alprostadil: results of a prospective, randomized trial. J Urol 1997; 158: 1408–1410.
28. Steers WD. physiology and pharmacology of the bladder and urethra. In: Walsh PC, Retik
AB, Vaughan ED. Jr, Sein AJ Campbell’s urology 7 th ed. USA: W.B. Saunders Copany 1998;
870–915.
29. Zvara P, Carrier S, Kour NW, Tanagho EA. The detailed neuroanatomy of the human striated
urethral sphincter. BJU 1994; 74: 182–187.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2011 Issue 1
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