A Foley’s Catheter is routinely used to document urinary output as a crucial determinant of adequate volume resuscitation in trauma.
In the presence of a major pelvic fracture, urinary catheterization requires special requires special consideration.
The incidence of concomitant injury to the bladder or urethra is about 20 percent.
if there is any suspicion of a urethral injury in male patients, it is advisable to obtain a urethrogram because Attempts to pass a catheter blindly through a partially disrupted male urethra can aggravate a partial tear and result in a stricture, incontinence, or impotence.
If the urethrogram indicates the passage of contrast medium into the bladder without extravasation, advance the catheter into the bladder.
Then perform a cystogram to exclude a rupture of the bladder.
Urologic management for a pelvic fracture victim
A Foley catheter can be placed directly into the bladder of a female patient because the risk is lesser owing to smaller size of urethra
If there is overt urethral injury then alternatives like use of suprapubic cystoscopy and drainage, urethral stent, or magnetic catheters should be considered.
In the typical pelvic fracture, a large pelvic hematoma usually distorts the image of the bladder.
The hematoma requires no specific treatment, although it may indicate a large blood loss and need for supplementary fluid or blood replacement. If a urethral injury is identified, a suprapubic cystoscopy may be indicated.
This procedure can be technically difficult in the presence of a large hematoma.
Recently, as a therapeutic alternative, radiographically visible stents have been inserted primarily into the site of the urethral disruption.
Magnetic catheters have been devised, which permit simultaneous urethral and suprapubic insertions.