Urologic Complications of Pelvic Fracture Flashcards
What percentage of blunt bladder injuries are associated with pelvic fractures?
Approximately 90% of blunt bladder injuries are associated with pelvic fractures
Only 10% of pelvic fractures are associated with bladder or urethral injury
What factors increase the likelihood of pelvic fracture urethral injury (PFUI)?
Wider pubic diastasis and increased displacement of ramus fractures
What are the most reliable indicators for bladder injury and pelvic fracture urethral injury (PFUI)?
gross hematuria and blood at the urethral meatus.
What is the best test for diagnosing bladder rupture
Retrograde cystography
What are additional indications for performing a retrograde cystogram in patients with pelvic fractures?
Inability to void,
Suprapubic pain
abdominal distention or significant intraperitoneal free fluid on imaging.
Should microscopic hematuria in pelvic fractures always prompt a retrograde cystogram?
imaging may be considered in patients with > 30 red blood cells per high-powered field
What is the exception to using RUG for diagnosing PFUI in trauma patients?
In female patients, due to their shorter urethra, cystourethroscopy is preferred
How do intraperitoneal bladder injuries typically occur?
from pelvic trauma to a full bladder, leading to rupture of the dome of the bladder
key finding on a cystogram for an intraperitoneal bladder rupture?
Contrast is seen in the peritoneal cavity, notably outlining loops of bowel.
typical finding on a cystogram for an extraperitoneal bladder rupture?
flame-shaped extravasation of contrast in the perivesical space
can spread to the retroperitoneum, scrotum, penis, abdominal wall, and thighs.
What are the potential complications of an intraperitoneal bladder rupture if not treated promptly?
peritonitis, sepsis, azotemia, and death.
intraperitoneal bladder ruptures be managed?
immediate operative exploration and repair
extraperitoneal bladder injuries typically managed?
conservatively with catheter drainage to allow the bladder to heal.
22Fr catheter
2 weeks, followed by a cystogram
antibiotics should be considered
When should extraperitoneal bladder injuries be managed operatively
Concurrent lacerations of the rectum, vagina, or bladder neck,
Presence of bony spicules in the bladder,
Significant hematuria causing clot obstruction of the catheter.
When should operative repair be considered if conservative management with catheter drainage fails?
if catheter drainage has failed after approximately 4 weeks.
In what situations should primary bladder repair be considered, even if bladder injury is not the primary concern?
if the patient is undergoing open reduction and internal fixation (ORIF) or abdominal exploration for other reasons
bladder lacerations be repaired?
two layers using slowly absorbable sutures.
The first layer mucosa and muscularis
second layer muscularis and serosa.
When should a follow-up cystogram be performed after bladder repair?
performed in 10 to 14 days
What area of the posterior urethra is particularly vulnerable in pelvic fracture urethral injury (PFUI)?
bulbo-membranous junction
What is diagnostic of PFUI on a retrograde urethrogram (RUG)?
Extravasation of contrast outside the posterior urethra
What does it suggest if contrast reaches the bladder on a RUG?
partial disruption of the urethra
What are the common complications associated with pelvic fracture urethral injury (PFUI)?
urinary incontinence, erectile dysfunction, and significant urethral strictures
Which PFUI patients should undergo primary repair to reduce the risk of fistula and incontinence?
concurrent rectal or bladder neck injury
What is the recommended management for female PFUI patients, especially with concurrent vaginal laceration?
early primary repair within the first 7 days,
reasonable initial approach for partial urethral disruption
A single attempt at blind catheter placement
What should be done in cases of complete urethral disruption or failed catheter placement?
suprapubic tube (SPT) placement or primary endoscopic urethral realignment
