Lower urinary tract injuries in patients with pelvic fractures at a level 1 trauma center – an 11-year experience

Abstract

Background

Urological injuries can occur in patients with pelvic fractures. Treatment recommendations lack solid evidence and is often pragmatical. There is a continuous need to describe short- and long-term morbidity following lower urinary tract trauma.

Objective

To describe incidence, diagnosis, treatment, and morbidity following lower urinary tract injuries in pelvic fractures.

Patients and methods

Retrospective study including patients with pelvic, including acetabular, fractures admitted to a Level I Trauma Centre covering 2.8 million citizens between 2009 and 2020. Outcome measurements comprised primary management, treatment trajectory, short- and long-term complications and outcomes.

Results

A total of 39 (5%) patients with pelvic fractures had concomitant urethral and/or bladder injuries, and one patient with an acetabular fracture had a bladder injury. The management of urethral injuries varied vastly, and complete urethral ruptures were associated with severe short- and long-term complications. Only one patient with bladder injury experienced severe long-term complications.

Conclusions

Management of lower urinary tract injuries in patients with major pelvic fractures remains a major challenge. Special attention should be focused on urethral injuries where we uncovered an unsystematic treatment and follow-up even in a highly experienced centre, although this is also attributed to complicated multidisciplinary patient trajectories. There is a continuous need to reduce long-term complications following urethral trauma which should be addressed in multicenter studies.

Keywords:

• Pelvic fracture
• trauma
• urethra
• bladder
• lower urinary tract

Ethical approval

All data collected about the patient health status and personal information were subject to secrecy. The data collected was stored in a database in anonymized form, according to Danish law regulations. Ethical approval for this study was obtained from Danish data protection agency.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the The Rigshospitalet Research Council.