Comparison of Micturition, Sexual and Defecation Disorders in Females Following type B and C Pelvic Fractures

Czech version

Authors: V. Džupa ^1,2; M. Očenášek ^1,3; J. Vránová ⁴; V. Ducháč ⁵; R. Grill ^1,6; V. Báča ^1,7
Authors‘ workplace: Centrum pro integrované studium pánve 3. LF UK, Praha, vedoucí lékař: doc. MUDr. Robert Grill, Ph. D. ¹; Ortopedicko-traumatologická klinika 3. LF UK a FNKV, Praha, přednosta: doc. MUDr. Martin Krbec, CSc. ²; Ústav pro péči o matku a dítě, Praha, ředitel: doc. MUDr. Jaroslav Feyereisl, CSc. ³; Ústav lékařské biofyziky a informatiky 3. LF UK, Praha, přednosta: doc. MUDr. Jozef Rosina, CSc. ⁴; Chirurgická klinika 3. LF UK a FNKV, Praha, přednosta: prof. MUDr. Robert Gürlich, CSc. ⁵; Urologická klinika 3. LF UK a FNKV, Praha, přednosta: doc. MUDr. Robert Grill, Ph. D. ⁶; Ústav anatomie 3. LF UK, Praha, přednosta: prof. MUDr. Josef Stingl, CSc. ⁷
Published in: Rozhl. Chir., 2011, roč. 90, č. 10, s. 579-583.
Category: Monothematic special - Original

Overview

Introduction:
The objective of this work is to present results obtained in a three-year study focussed on micturition, defecation and sexual disorders in women of active age.

Methods:
The monitored set consisted of 33 female patients treated in 2004–2009 for unstable pelvic fracture (B-type or C-type according to AO classification). Out of them 25 patients suffered B-type fracture and 8 patients suffered C-type fracture. Their age ranged between 17 and 55 years (the average age was 32 years).

Anamnestic data were obtained based on UIQ, UDI and PISQ12 questionnaires.

The non-parametric Mann-Whitney U-test was used for answers to individual questions representing nominal/ordinal variables. After finding a statistically significant difference in answers between both groups of patients, it was investigated by means of Pearson χ²-test which answers are behind this statistically significant difference. If the number of answers to any question was less than 5, the exact Fisher test was used. In the event the rate equalled 0, Haldane correction was applied. All tests were considered statistically significant if the significance level was below 5%.

Results:
The occurrence of urologic problems was higher in the B-type fracture patients (84% vs. 50%), however, afflictions were more severe in the C-type fracture patients. Intestinal problems were more frequent in the C-type fracture patients (75% vs. 52%) and they were also more severe. Also sexual problems were more frequent in the C-type fracture patients (75% vs. 40%), although according to individual answers it was not possible to state that their sexual life was unequivocally worse.

Conclusion:
The analysis of comparison of micturition, sexual and defecation problems in patients one year after the unstable pelvic fracture showed in some respects higher problems in the patients who had suffered the C-type fracture. However, more important are the following observations, generally related to unstable pelvic fracture patients: 1. The occurrence of micturition, sexual and defecation problems was unexpectedly high; 2. Without active examination by a traumatologist during the after-treatment ”minor” problems may escape his/her attention and may negatively affect life of each individual patient in the longer run; 3. A targeted method of detection of problems by means of questionnaires could lead to their disclosure; 4. A urologist, urogynaecologist, sexologist and proctologist have an indisputable place in the treatment of women who suffered a severe pelvic trauma.

Key words:
urinary incontinence – voiding dysfunction – sexual dysfunction – instable pelvic fracture

Sources

1. Draijer, F., Egbers, H. J., Havemann, D. Quality of life after pelvic ring injuries: follow-up results of a prospective study. Arch. Orthop. Trauma. Surg., 1997, roč. 116, s. 22–26.

2. Heinermann, J. D., Hessmann, M. H., Rommens, P. M. Akzidentelles Seitspagat als Ursache eines komplexen Beckentraumas. Unfallchirurg, 2005, roč. 108, s. 319-321.

3. Kabak, S., Halici, M., Tuncel, M., Avarogullari, L., Baktir, A., Bastruk, M. Functional outcome of the open reduction and internal fixation for completely unstable pelvic ring fractures (type C): a report of 40 cases. J. Orthop. Trauma, 2003, roč. 17, s. 555–562.

4. Malavaud, B., Mouzin, M., Tricoire, J. L., Gamé, X., Rischmann, P., Sarramon, J. P., Puget, J. Evaluation of male sexual function after pelvic trauma by the international index of erectile function. Urology, 2000, roč. 55, s. 842–846.

5. Siegmeth, A., Müllner T., Kukla, C., Vécsei, V. Begleitverletzungen beim schweren Beckentrauma. Unfallchirurg, 2000, roč. 103, s. 572–581.

6. Šrámková, T., Filipinský, J., Sutorý, M., Wendsche, P., Kočiš, J. Erektilní dysfunkce po poranění pánve. Rozhl. Chir., 2005, roč. 84, s. 299–302.

7. Tauber, M., Joos, H., Karpik, S., Lederer, S., Resch, H. Urogenitale Begleitverletzungen bei Beckenringfracturen. Unfallchirurg, 2007, roč. 110, s. 116–123.

8. Reilly, M. C., Zinar, D. M., Matta, J. M. Neurologic injuries in pelvic ring fractures. Clin. Ortop., 1996, roč. 329, s. 28–36.

9. Roche, B., Michel, J. M., Deléaval, J., Peter, R., Marti, M. C. Lésions traumatiques de l‘anorectum. Swiss Surg., 1998, roč. 4, s. 249–252.

10. Baessler, K., Bircher, M. D., Stanton, S. L. Pelvic floor dysfunction in women after pelvic trauma. Br. J. Obstet. Gyneacol., 2004, roč. 111, s. 499–502.

11. Rommens, P. M., Hessmann, M. H. Staged reconstruction of pelvic ring disruption: differences in morbidity, mortality, rediologic results, and functional outcomes between B1, B2/B3, and C-type lesions. J. Orthop. Trauma, 2002, roč. 16, s. 92–98.

12. Routt, M. L. Jr., Nork, S. E., Mills, W. J. High-energy pelvic ring disruptions. Orthop. Clin. North. Am., 2002, roč. 33, s. 59–72.

13. Tosounidis, G., Holstein, J.H., Culemann, U., Holmenschlager, F., Stuby, F., Pohlemann, T. Changes in epidemiology and treatment of plevic ring fractures in Germany: an analysis on data of German Pelvic Multicenter Study groups I and III (DGU/AO). Acta Chir. orthop. Traum. čech., 2010, roč. 77, s. 450–156.

14. Pohlemann, T., Regel, G., Tscherne, H. Klassifikation und Begriffsbestimmungen. In: Tscherne, H., Pohlemann, T. (Hrsg): Becken und Acetabulum. Berlin, Springer 1998, s. 47–62.

15. Barzilay, Y., Liebergall, M., Safran, O., Khoury, A., Mosheiff, R. Pelvic fractures in a Level I Trauma Center: a test case for the efficacy of the evolving trauma system in Israel. Isr. Med. Assoc. J., 2005, roč. 7, s. 619–622.

16. Džupa V., Chmelová J., Pavelka T., Obruba P., Wendsche P., Šimko P., Filipinský J., Kloub M., Pleva L., Kopp L., Malkus T., Frank M., Magala M., Lisý M., Rovder P., Dráč P., Křivohlávek M., Višňa P. Multicentrická studie pacientů s poraněním pánve: základní analýza souboru. Acta Chir. orthop. Traum. čech., 2009, roč. 76, s. 404–409.

17. Ježek, M., Džupa, V. Vliv věku pacienta a mechanizmu úrazu na typ zlomeniny pánve: epidemiologická studie. Acta Chir. orthop. Traum. čech., v tisku.

18. Tile, M., Helfet, D. L., Kellam, J. F. (Eds) Fractures of the pelvis and acetabulum. 3^rd edition. Philadelphia, Lippincott Williams & Wilkins 2003.

19. Miranda, M. A., Riemer, B.L., Butterfield, S.L., Burke, C. J. 3rd Pelvic ring injuries: a long term functional outcome study. Clin. Orthop., 1996, roč. 329, s. 152–159.

20. Pohlemann, T., Gänsslen, A., Schellwald, O., Culemann, U., Tscherne, H. Outcome after pelvic ring injuries. Injury, 1996, roč. 27 (Suppl. 2), s. 31–38.

21. Otčenášek, M., Krofta, L., Báča, V., Grill, R., Kučera, E., Herman, H., Vasicka, I., Drahoňovský, J., Feyereisl, J. Bilateral avulsion of the puborectal muscle: MRI based 3-D reconstruction and comparison with a model of healthy nulliparous women. Ultrasound Obstet. Gynecol., 2007, roč. 29, s. 692–696.