Pelvic Fracture Urethral Injury in Females

• Published in: Société internationale d'urologie journal Vol. 3; no. 2; pp. 77 - 86
• Main Authors: Joshi, Pankaj M., Bandini, Marco, Yepes, Christian, Bhadranavar, Shreyas, Sharma, Vipin, Bafna, Sandeep, Kulkarni, Sanjay B.
• Format: Journal Article
• Language: English
• Published: The Société Internationale d’Urologie (SIU) 08.03.2022
• Subjects: female urethroplasty; fistula; pelvic fracture urethral injury; stricture; urethra
• ISSN: 2563-6499; 2563-6499
• DOI: 10.48083/MBXR6354

Background Pelvic fracture urethral injuries (PFUI) in females are very rare. The available literature on the management of this condition is scarce and not clear, mainly because of limited experience among reconstructive surgeons. We present our experience of management of these complex urethral injuries in female patients. Materials and Methods We collected data, retrospectively and prospectively for 22 female patients referred to our center for PFUI repair between 1995 and 2021. During the clinical assessment of these complex injuries, following our internal institutional protocol, all patients underwent pelvic MRI (bladder and urethra are filled with saline solution and jelly to enhance the urethral lumen and the level of the distraction) before anastomotic urethroplasty. Results PFUI compromised the mid urethra in 10 patients (45.5%). A transabdominal approach was used in 8 patients (80%), and urethra-vaginal fistula repair was undertaken in 6 patients (60%). After a median follow-up of 36 months, only 1 patient with proximal PFUI required a surgical revision without compromising urinary continence. Conclusions The most common site of urethral involvement in pelvic fracture is mid urethral, which is owing to avulsion. Urethra-vaginal fistula should be suspected. Treatment consists in anastomotic urethroplasty, mainly through the abdominal approach.