Urethral Injury Management in Pelvic Fractures

Urethral injuries associated with pelvic fractures predominantly affect the posterior urethra and arise from high-energy trauma such as road traffic collisions or falls from height. Initial diagnosis relies on clinical assessment and imaging, notably retrograde urethrography, to distinguish partial from complete disruptions. Acute management typically involves suprapubic cystostomy to divert urine and decompress the injured urethra. Debate persists over early endoscopic realignment versus delayed reconstruction; early realignment may reduce stricture length and facilitate later repair, but carries a risk of false passages and urinary incontinence. The gold standard for established distraction defects remains delayed excision of fibrosis and tension-free primary anastomosis via a transperineal or combined perineo-abdominal approach. Recent refinements include the use of interposed flaps and sealants to bolster anastomotic healing, as well as advanced imaging modalities such as tailored magnetic resonance protocols to inform surgical planning. Long-term follow-up focuses on functional outcomes, continence preservation and sexual function, recognising that multidisciplinary rehabilitation is key to optimal recovery.

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Urethral Injury Management in Pelvic Fractures publication trend

The graph below shows the total number of articles in urethral injury management in pelvic fractures across all publications each year (not limited to Nature Index journals).

Technical terms

Pelvic fracture urethral injury (PFUI): Disruption of the urethra, typically posterior, occurring in association with pelvic ring fractures.

Suprapubic cystostomy: Placement of a catheter directly into the bladder through the lower abdominal wall for urinary diversion.

Endoscopic realignment: Minimally invasive alignment of urethral ends over a catheter, performed acutely to reduce stricture formation.

Urethroplasty: Definitive surgical reconstruction of the urethra, usually involving excision of scar tissue and primary anastomosis.

Transperineal anastomosis: Posterior approach through the perineum allowing direct excision of fibrotic tissue and reconnection of urethral segments.

References

1. Transperineal anastomotic posterior urethroplasty with bulbocavernosus flap and fibrin sealant in the complicated posterior urethral stricture reconstruction: a retrospective cohort study. International Journal of Surgery (2023).
2. Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians. Journal of Clinical Medicine (2023).
3. Magnetic resonance imaging procedure for pelvic fracture urethral injuries and recto urethral fistulas: A simplified protocol. Urology Research and Practice (2021).