Visceral injuries are a potential source of life-threatening complications in a pelvic fracture. Injury to the lower urinary tract is a common consequence of a disruption of the anterior pelvic ring, and it can involve the ureter or, more commonly, the bladder and urethra.
Urogenital system injury (injury to urethra, bladder, kidney) occurs in as many as 25% of all cases involving disruption of the pelvic ring.
It is more common with bilateral pubic arch injury. Potential sites of visceral injury with a pelvic fracture. other potential sites of injury are
- Large and small Intenstines
- Bladder and urethra
- Vagina
- Rectum
- Other intraabdominal structures
Commonest injury to occur in viscera is injury to urethra. Male urethra being longer than females is at higher risk than female urethra.
Classic area for urethral disruption is just distal to the apex of the prostate gland. and at the juncture of the membranous urethra and the bulbous urethra.
A presence of blood at the meatus ( tip of the urethra) is suggestive of urethral tear. Other features that are suggestive of a urethral tear include , local swelling, the inability to void, gross hematuria, or a high-riding prostate gland.
If any of these signs are present, a dynamic retrograde urethrogram prior to the insertion of a urinary catheter to rule out a significant urethral injury must be done.
In female patients, a meticulous gynecologic examination is essential, particularly in the presence of vaginal bleeding.
A cystogram can be done after the injury to evaluate bladder.
Most urologists favor a delayed urethral reconstruction, which in their view lowers the risk of impotence, incontinence, and urethral stricture.
When the urologic injury is a rupture of the bladder, an acute surgical repair may be indicated.
In the presence of a stable pelvic fracture and an extrepeitoneal bladder injury, nonoperative management of both problems may be done.
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