EXPERIENCE WITH LOWER URINARY-TRACT DISRUPTIONS ASSOCIATED WITH PELVIC FRACTURES - IMPLICATIONS FOR EMERGENCY ROOM MANAGEMENT

A retrospective review of prospectively gathered data from 249 trauma patients was undertaken to study the association of lower urinary tract disruptions with pelvic fractures and to confirm guidelines for the initial investigation and management of such patients in the emergency room. Of 249 patients with pelvic fractures, 124 (50%) had haematuria and 17 (7%) had lower urinary tract disruptions (7 urethral ruptures, 9 bladder ruptures and 1 patient with both bladder and urethral ruptures). Gross haematuria or blood at the urethral meatus was noted in 16 of 17 patients with urological injuries. Twenty-five per cent of patients with unstable pelvic fractures had lower urinary tract disruption compared to 6% of patients with stable fractures (P < 0.05). Retrograde urethrography followed by cystography is indicated in all cases of pelvic fractures with blood at the urethral meatus, macroscopic haematuria or associated signs such as inability to void and perineal haematoma. Urinary diversion alone was used in partial urethral ruptures while surgical exploration and repair were performed in complete urethral ruptures and in most cases of bladder ruptures.