Risk factors for lower urinary tract injuries in patients with traumatic pelvic fractures

Choi, Do Yeoun; Park, Hae Young

Abstract

For identification of the risk factors for lower urinary tract injuries in patients with pelvic fractures, we reviewed the records of 332 patients with pelvic fractures and 60 patients with urethral or bladder ruptures not associated with pelvic fractures seen at our hospital during recent 5 years. The incidence of lower urinary tract injuries in patients with pelvic fractures was 9.9 per cent (urethra 57.6 per cent, bladder 36.4 per cent. and both 6.0 per cent).Of the 181 simple rami fractures 21 (11.6 percent) had lower urinary tract injuries. Of the 90 rami fractures combining other fractures 11 (12.2 per cent} had lower urinary tract injuries, especially 5 (50.0 per cent) of the 10 combining symphysis pubis diastasis. Of the 14 bladder ruptures 13 had gross hematuria, and of the 21 urethral ruptures all had blood at urethral meatus. For evaluation of significance of hematuria as a indicator for bladder ruptures, we reviewed 257 pelvic fractures without urethral ruptures and upper tract injuries. While of the 25 cases with gross hematuria 13 (52.0 percent) had bladder ruptures, of the 76 cases with only microscopic hematuria 1 case had bladder rupture. We conclude that the high risk factors for lower urinary tract injuries in patients with pelvic fractures are both rami fracture, dispacement of hemipelvis, and symphysis pubis diastasis. Therefore prompt diagnostic procedures for urethral and bladder ruptures must be performed in those cases, especially when combined with gross hematuria or blood at urethral meatus.