Epidemiology of posterior urethral injury among adults with traumatic pelvic ring disruptions: a 10-year retrospective review from a trauma care centre in Southeast Nigeria

Abstract

Introduction: posterior urethral injuries can occur in polytrauma settings, and may contribute to morbidity post-trauma. The aim of this study is to determine the occurrence of pelvic fracture urethral injury (PFUI) in adult polytrauma patients who were successfully stabilized and to appraise the nature of associated injuries.

Methods: the medical records of stabilized polytrauma patients ≥ 18 years of age from January 2010 to December 2019 were retrospectively reviewed focusing on those presenting with bony pelvis disruptions. Injuries were categorized using the injury severity scale (ISS) while bony pelvis disruptions were classed according to the Young-Burgess classification. Data on the demography of the patient, mechanism of injury, nature, and severity of injuries, class of pelvic fracture-disruption, and urethral integrity were collected and analyzed accordingly.

Results: of 111 patients with bony pelvis disruptions, 95 of them had adequate information and were included in our analysis. The mean age of participants was 37.3 ± 11.8 years and most of them were males (87.4%). Blunt pelvic trauma occurred in 96.8%. Lateral compression pelvic injuries were prevalent at 39.0%. In 54.7% of the patients, the injury severity score (ISS) was ≥ 27. At 25.3% and 24.2% respectively, the abdomen and the lower extremities most frequently sustained a grade ≥ 3 injuries (abbreviated injury scale (AIS) ≥3). At a rate of 2.1%, spinal cord injury was the least observed. In the 10 years, there were 6 PFUI among 83 stabilized polytraumatized men with mean ISS of 35.5 ± 8.3. The incidence rate of PFUI was 0.6 per 8.3 pelvic disruptions in men per year. Symphysis pubis disruption or fracture of the pubis or both was consistently seen in all PFUI. Higher ISS significantly relates to PFUI (p <0.001). The mechanism of bony pelvis disruption and the class of bony pelvis injury are determined by the severity and trajectory of the impact apparently relates to PFUI only through fracture-disruption of the pubic symphysis or the pubis.

Conclusion: about 7.2% of men presenting with traumatic disruption of the bony pelvis in polytrauma setting sustain PFUI. In polytrauma settings, PFUI should be suspected in cases of fracture-disruption of the pubis or symphysis pubis from any mechanism.