Urologic Complications of Pelvic Fracture

Question 1

What percentage of blunt bladder injuries are associated with pelvic fractures?

Answer 1

Approximately 90% of blunt bladder injuries are associated with pelvic fractures
Only 10% of pelvic fractures are associated with bladder or urethral injury

Question 2

What factors increase the likelihood of pelvic fracture urethral injury (PFUI)?

Answer 2

Wider pubic diastasis and increased displacement of ramus fractures

Question 3

What are the most reliable indicators for bladder injury and pelvic fracture urethral injury (PFUI)?

Answer 3

gross hematuria and blood at the urethral meatus.

Question 4

What is the best test for diagnosing bladder rupture

Answer 4

Retrograde cystography

Question 5

What are additional indications for performing a retrograde cystogram in patients with pelvic fractures?

Answer 5

Inability to void,
Suprapubic pain
abdominal distention or significant intraperitoneal free fluid on imaging.

Question 6

Should microscopic hematuria in pelvic fractures always prompt a retrograde cystogram?

Answer 6

imaging may be considered in patients with > 30 red blood cells per high-powered field

Question 7

What is the exception to using RUG for diagnosing PFUI in trauma patients?

Answer 7

In female patients, due to their shorter urethra, cystourethroscopy is preferred

Question 8

How do intraperitoneal bladder injuries typically occur?

Answer 8

from pelvic trauma to a full bladder, leading to rupture of the dome of the bladder

Question 9

key finding on a cystogram for an intraperitoneal bladder rupture?

Answer 9

Contrast is seen in the peritoneal cavity, notably outlining loops of bowel.

Question 10

typical finding on a cystogram for an extraperitoneal bladder rupture?

Answer 10

flame-shaped extravasation of contrast in the perivesical space
can spread to the retroperitoneum, scrotum, penis, abdominal wall, and thighs.

Question 11

What are the potential complications of an intraperitoneal bladder rupture if not treated promptly?

Answer 11

peritonitis, sepsis, azotemia, and death.

Question 12

intraperitoneal bladder ruptures be managed?

Answer 12

immediate operative exploration and repair

Question 13

extraperitoneal bladder injuries typically managed?

Answer 13

conservatively with catheter drainage to allow the bladder to heal.
22Fr catheter
2 weeks, followed by a cystogram
antibiotics should be considered

Question 15

When should extraperitoneal bladder injuries be managed operatively

Answer 15

Concurrent lacerations of the rectum, vagina, or bladder neck,
Presence of bony spicules in the bladder,
Significant hematuria causing clot obstruction of the catheter.

Question 16

When should operative repair be considered if conservative management with catheter drainage fails?

Answer 16

if catheter drainage has failed after approximately 4 weeks.

Question 17

In what situations should primary bladder repair be considered, even if bladder injury is not the primary concern?

Answer 17

if the patient is undergoing open reduction and internal fixation (ORIF) or abdominal exploration for other reasons

Question 18

bladder lacerations be repaired?

Answer 18

two layers using slowly absorbable sutures.
The first layer mucosa and muscularis
second layer muscularis and serosa.

Question 19

When should a follow-up cystogram be performed after bladder repair?

Answer 19

performed in 10 to 14 days

Question 20

What area of the posterior urethra is particularly vulnerable in pelvic fracture urethral injury (PFUI)?

Answer 20

bulbo-membranous junction

Question 21

What is diagnostic of PFUI on a retrograde urethrogram (RUG)?

Answer 21

Extravasation of contrast outside the posterior urethra

Question 22

What does it suggest if contrast reaches the bladder on a RUG?

Answer 22

partial disruption of the urethra

Question 23

What are the common complications associated with pelvic fracture urethral injury (PFUI)?

Answer 23

urinary incontinence, erectile dysfunction, and significant urethral strictures

Question 24

Which PFUI patients should undergo primary repair to reduce the risk of fistula and incontinence?

Answer 24

concurrent rectal or bladder neck injury

Question 25

What is the recommended management for female PFUI patients, especially with concurrent vaginal laceration?

Answer 25

early primary repair within the first 7 days,

Question 26

reasonable initial approach for partial urethral disruption

Answer 26

A single attempt at blind catheter placement

Question 27

What should be done in cases of complete urethral disruption or failed catheter placement?

Answer 27

suprapubic tube (SPT) placement or primary endoscopic urethral realignment