Trauma to the pelvis: urethral injury. 1980

V Colapinto

Currently, discrepancies exist in published reports regarding both the site and the extent of the urethral injury in fractured pelvis, as well as in the incidence of the major postoperative complications, namely, stricture and impotence. There is also debate as to the best method of initial treatment of the injury, this is, primary vs. delayed repair. We believe that much of the controversy is the result of inaccurate diagnosis of the site and extent of the initial injury. In the past, diagnosis has depended upon clinical criteria or on the failure of a catheter to traverse the urethra. These methods fail to pinpoint the site of the injury, nor do they tell us whether the rupture is incomplete, partial or complete. Fortunately, much of this information can be obtained by dynamic retrograde urethrography. Using dynamic retrograde urethrography routinely in the initial diagnosis, we have found that: the urethral rupture occurs most often below the urogenital diaphragm rather than above it as is traditionally believed; the patient may have the clinical criteria for complete rupture when his urethra is actually intact or only partially severed; an incomplete or even a small partial rupture may be present in spite of negative clinical criteria. These new concepts have contributed greatly to clarifying current controversies regarding the incidence of posttraumatic stricture and erectile impotence, and will have an influence on surgical techniques in the future. Unfortunately, the value of dynamic retrograde urethrography is not yet common knowledge. Our aim is to convince the orthopedic surgeon, who usually sees the patient first, to postpone urethral catheterization in patients with fractured pelvis until dynamic retrograde urethrography has been done. The technique is simple, takes little time, and requires no special equipment. In a severe emergency it can be done by the attending staff without the help of a radiologist. Ideally, dynamic retrograde urethrography should be obtained in all severe pelvic fractures regardless of the lack of clinical criteria of urethral injury.

UI MeSH Term Description Entries
D007172 Erectile Dysfunction The inability in the male to have a PENILE ERECTION due to psychological or organ dysfunction. Impotence,Male Impotence,Male Sexual Impotence,Dysfunction, Erectile,Impotence, Male,Impotence, Male Sexual,Sexual Impotence, Male
D008297 Male Males
D010384 Pelvic Bones Bones that constitute each half of the pelvic girdle in VERTEBRATES, formed by fusion of the ILIUM; ISCHIUM; and PUBIC BONE. Coxal Bone,Hip Bone,Innominate Bones,Bone, Coxal,Bone, Hip,Bone, Innominate,Bone, Pelvic,Bones, Coxal,Bones, Hip,Bones, Innominate,Bones, Pelvic,Coxal Bones,Hip Bones,Innominate Bone,Pelvic Bone
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012421 Rupture Forcible or traumatic tear or break of an organ or other soft part of the body. Ruptures
D014521 Urethra A tube that transports URINE from the URINARY BLADDER to the outside of the body in both the sexes. It also has a reproductive function in the male by providing a passage for SPERM. External Urethral Sphincter,External Urinary Sphincter,Internal Urethral Sphincter,Internal Urinary Sphincter,Internal Vesical Sphincter,Urethral Sphincters,External Urethral Sphincters,External Urinary Sphincters,Internal Urethral Sphincters,Internal Urinary Sphincters,Internal Vesical Sphincters,Sphincter, External Urethral,Sphincter, External Urinary,Sphincter, Internal Urethral,Sphincter, Internal Urinary,Sphincter, Internal Vesical,Sphincter, Urethral,Urethral Sphincter,Urethral Sphincter, External,Urethras,Urinary Sphincter, External,Urinary Sphincter, Internal,Vesical Sphincter, Internal
D014525 Urethral Stricture Narrowing of any part of the URETHRA. It is characterized by decreased urinary stream and often other obstructive voiding symptoms. Urethral Stenosis,Anterior Urethral Stricture,Posterior Urethral Stricture,Urethral Stricture, Anterior,Urethral Stricture, Posterior,Anterior Urethral Strictures,Posterior Urethral Strictures,Stenoses, Urethral,Stenosis, Urethral,Stricture, Urethral,Strictures, Urethral,Urethral Stenoses,Urethral Strictures,Urethral Strictures, Anterior,Urethral Strictures, Posterior
D014567 Urography Radiography of any part of the URINARY TRACT. Pyelography,Pyelogram,Urogram,Pyelograms,Pyelographies,Urograms,Urographies
D050723 Fractures, Bone Breaks in bones. Bone Fractures,Broken Bones,Spiral Fractures,Torsion Fractures,Bone Fracture,Bone, Broken,Bones, Broken,Broken Bone,Fracture, Bone,Fracture, Spiral,Fracture, Torsion,Fractures, Spiral,Fractures, Torsion,Spiral Fracture,Torsion Fracture

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