Session VII - Pelvic Trauma

Pelvic Ring Injury and Associated Urologic Trauma: Results of Multicenter Study

Fred Draijer, MD, Heinz-Jürgen Egbers, MD, Dieter Havemann, MD

Hospital of Accident Surgery, University of Kiel, Kiel, Germany

Method: Injuries of the genitourinary system are the most frequent pelvic- associated lesions in pelvic fractures. Especially, injuries of the urethra are accompanied in a high percentage by late sequelae like development of a urethral stricture and erectile impotence. In a multicenter study of the Pelvic Group of the German Association of Accident Surgery and ASIF, 1,722 patients with pelvic injuries could be recorded from 1991 to 1993 in 10 trauma departments.

Results: Associated pelvic injuries could be observed in 14.1% (n=243), most frequently lesions of the genitourinary systems and neurological injuries. Ruptures of the bladder could be found in 3.8% (n=65) and urethral injuries in 1.9% (n=33) of all pelvic injuries. Remarkable is the greater incidence of lesions of the bladder and urethra after B3-injuries in comparison to C-lesions. In the overall group of pelvic injuries, lesions of the bladder (20.7%) and also urethral injuries (10.3%) were most frequently found in type B3-injuries. A complex pelvic trauma existed in 160 patients (9.3%). As expected, the part of associated urological injuries correlates to the accompanying pelvic ring instability; they could be observed more frequently in more severe pelvic ring trauma. Four hundred eighty-six patients of the years 1991 and 1992 with type B- and type C-lesions, acetabular fractures, complex traumas and 25% of all type A-injuries could be followed-up after 2 years, follow-up rate was 73%. Micturition difficulties could be observed in 7.6% (n=37), in men the frequency was 2 to 3 times greater than in women (n=11). As expected, the part of micturition difficulties (with and without subjective disturbance) was the greatest with 20.6% in the group of complex traumas, the 11.1% disturbances of type A-injuries are remarkable. The 37 micturition difficulties could be divided into 32 dysfunctions without residual urine not felt as hindering and 5 difficulties with residual urine and/or subjective hindering dysfunction. In the follow-up, sexual dysfunctions (erectile dysfunction, sexual intercourse pain) could be found in 11.6% of 302 men (n=35) and in 2.2% of 184 women (n=4). Subjective hindering dysfunctions could only be found in 7 men, in women only subjective not hindering sequelae were observed. The 32 subjective not hindering sexual dysfunctions were found in 28 men and 4 women.