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Risk Factors Associated with Lower Urinary Tract Injuries in Traumatic Pelvic Fractures

Vaite Tsing, Jessica NG and Martin Wullschleger

Background: Bladder and urethral injuries associated with pelvic fractures are uncommon and are missed at initial assessment in up to 23% of cases. Missed lower urinary tract injuries have a significant impact on patient morbidity, if not identified early. This study aims to associate mechanisms of traumatic pelvic ring fractures with bladder and/or urethral injuries to determine factors that may increase odds of injury.

Methods: In a retrospective cohort study, all patients 13 years and older admitted to Gold Coast Health Service from 2010 to 2016 with traumatic pelvic injuries and lower urinary tract injuries were identified. Mechanism of injury and types of pelvic fractures were evaluated and clinical symptoms and treatment analysed.

Results: 333 patients with pelvic fractures were identified: seven sustained urethral injuries, three bladder injuries and one with both. Common mechanisms included crush injuries (40%) with a statistical significant correlation (p=0.47), falls from height (30%) and road traffic accidents (30%). Associated types of pelvic fractures comprised of lateral compression (40%), anterior-posterior compression (40%) and vertical shear (20%).

Conclusion: As identified in this retrospective study, concomitant lower urinary tract injuries and pelvic fractures are rare. Although a significant correlation with types of pelvic fracture could not be determined, there is a clear association with high-energy trauma. Therefore, it is important to actively look for and exclude bladder and urethral injuries in this patient group. Further research with a larger prospective study could provide a greater insight into correlations.