Urethral injury and fractured pelvis

Abstract

In 333 consecutive cases of fractures of the pelvis admitted as emergencies to one hospital 53% were in males, of whom 34 had suspicious clinical signs of urethral or vesical injury. In 15 patients catheterisation was performed uneventfully and in no case did this make the injury worse; in 8 an attempt at primary realignment was performed, resulting in 4 cases without any stricture, and 2 who needed annual dilation only. In 4 additional cases associated laceration of the bladder was repaired of which one had no stricture and 2 needed infrequent dilatations. In a further 41 cases a catheter was used and led to no strictures. Among 67 males with post-traumatic urethral injuries caused by pelvic fracture the best results were seen when the 2 ends were approximated. In 4 cases a stricture was prevented entirely, and in 17 others it led to an easy urethroplasty. Difficult strictures occurred in severe injuries with uncorrected displacement of the soft parts. Where feasible, early surgical repair appears to give the best chance of minimising the severity of subsequent urethral stricture.