The lower urinary tract injuries in pelvic ring fractures
Article published in Urologia Polska 2006/59/1.

authors

Paweł Malik ^1,2, Krzysztof Bar ³, Jacek Niezabitowski ², Andrzej Ciołko ², Piotr Paluszkiewicz ⁴, Karol Dudka ², Tomasz Lübek ⁵, Paweł Płaza ⁶: ¹ Międzywydziałowa Katedra i Zakład Zdrowia Publicznego Akademii Medycznej w Lublinie
² Oddział Urologii Wojewódzkiego Szpitala Specjalistycznego w Lublinie
³ Katedra i Klinika Urologii Akademii Medycznej w Lublinie
⁴ Oddział Chirurgii Ogólnej Wojewódzkiego Szpitala im. Jana Bożego w Lublinie
⁵ Katedra i Klinika Chirurgii Urazowej i Medycyny Ratunkowej Akademii Medycznej w Lublinie
⁶ Katedra i Zakład Anatomii Prawidłowej Człowieka Akademii Medycznej w Lublinie

keywords

pelvic trauma, urinary bladder injury, urethral injury

summary

Introduction. The efficient treatment of pelvis fractures depends on concomitant injuries of the distant urinary and digestive tracts. Therefore the treatment of patients with pelvic fractures in many cases involves the teamwork of orthopaedists, surgeon-traumatologists and urologists.

The aim of the paper. Estimation of the incidence of the lower urinary tract injuries in patients with pelvic fractures.

Material and method. Retrospective analysis of medical history of 272 pelvic bone fracture patients treated in 11 - years period (1993-2003) in selected hospitals of Lublin.

Results. The lower urinary tract injuries went together with severe multiorgan injuries and complicated pelvic fractures. The most frequent type of fracture was the simultaneous injury of the pubic and ischiadic bone.

Conclusions. Urethral injuries occur mainly in male patients; in case of the urinary bladder injuries these proportions in female and male patients are similar. In patients with ischiadic bones fractures, simultaneous pubic and ischiadic bone fractures or comminuted fractures, registered risk of distant urinary tract injury was increased.

references

1. Taffet R: Management of pelvic fractures with concomitant urologic injuries. Orthop Clin North Am 1997, 28, 389-396.
2. Watnik NF, Coburn M, Goldberger M: Urologic injuries in pelvic ring disruptions. Clin Orthop 1996, 329, 37-45.
3. Brandes S, Borrelli J Jr: Pelvic fracture and associated urologic injuries. World J Surg 2001, 25, 1578-1587.
4. Dobrowolski Z, Lipczyński W, Kusinowicz i in: Urazy zewnętrzne i jatrogenne pęcherza moczowego zaopatrzone na oddziałach urologii w Polsce w latach 1995-1999. Urol Pol 2002, 2, 45-47.
5. Dobrowolski Z, Węglarz W, Woliński L i in: Diagnostyka i leczenie 268 przypadków urazów cewki tylnej. Urol Pol 2002, 1, 57-59.
6. Deane A: ABC of major trauma. Trauma of the lower urinary tract. BMJ 1990, 301, 545-547.
7. Borkowski A, Borówka A: Urazy narządów miednicy mniejszej i zewnętrznych narządów płciowych, Warszawa, PZWL, 1990, 40-59.
8. Dobrowolski Z, Węglarz W, Jakubik P et al: Treatment of posterior and anterior urethral trauma. Br J Urol 2002, 89, 752-754.
9. Lynch TH, Martinez-Pineiro L, Plas E et al: EAU Guidelines on Urological Trauma. Eur Urol 2005, 47, 1-15.
10. Dobrowolski Z, Lipczyński W, Drewniak T et al: External and iatrogenic trauma of the urinary bladder: a survey in Poland. Br J Urol 2002, 89, 755-756.
11. Aihara R, Blansfield JS, Millham FH et al: Fracture locations influence the likelihood of rectal and lower urinary tract injuries in patients sustaining pelvic fractures. J Trauma 2002, 52, 205-209.
12. Antoci JP, Shiff M Jr: Bladder and urethral injuries in patients with pelvic fractures. J Urol 1982,128, 25-26.
13. Koraitim MM: Pelvic fracture urethral injuries: The unresolved controversy. J Urol 1999, 161, 1433-1441.
14. Demetriades D, Karaiskakis M, Toutouzas K: Pelvic fractures: Epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg 2002, 195, 1-10.
15. Hsieh CH, Chen RJ, Fang JF et al: Diagnosis and management of bladder injury by trauma surgeons. Am J Surg 2002, 184, 143-147.

correspondence