Urethral and Bladder Injuries Associated with Pelvic Fractures
DNB Orthopaedics • October 2024 • Paper III • 10 Marks
Introduction
Pelvic fractures may be associated with injuries to the lower urinary tract, particularly the posterior urethra and urinary bladder. These injuries are important because missed lesions may lead to urinary extravasation, infection, urethral stricture, incontinence and long-term functional impairment.
Core orthopaedic principle
In a pelvic fracture patient, blood at the urethral meatus, inability to void or gross haematuria should immediately raise suspicion of associated urological injury.
Relevant Anatomy
Male urethra
| Part | Components | Trauma Relevance |
|---|---|---|
| Anterior urethra | Bulbar + penile urethra | More commonly injured by straddle trauma |
| Posterior urethra | Membranous + prostatic urethra | Classically associated with pelvic-ring disruption |
The membranous urethra is relatively fixed at the urogenital diaphragm, whereas the prostate and bladder move with disruption of the pelvic ring. This difference in mobility contributes to injury around the bulbomembranous / prostatomembranous junction.
Patho-anatomy of Pelvic Fracture Urethral Injury
Posterior urethral injury usually results from severe pelvic-ring disruption, particularly injuries producing displacement of the hemipelvis or pubic symphysis.
Injury may range…