OBJECTIVE: To develop a new functional and anatomical classification of urethral injury secondary to pelvic fracture. MATERIAL AND METHODS: Fifty-six male patients (20 children, 36 adults) with urethral injuries secondary to pelvis fracture were evaluated. Clinical examination, retrograde urethrogram immediately after the accident, operative findings in the emergency state, subsequent combined retrograde urethrography and suprapubic cystography, operative findings during urethral reconstruction and postoperative follow-up were critically reviewed retrospectively. RESULTS: A new classification of urethral injury secondary to pelvic fracture is proposed as a result of our findings: Type 1. Injury to the prostate; 1a. Proximal avulsion of the prostate; 1b. Incomplete or complete trans-prostatic rupture. Type 2. Stretching of the membranous urethra. Type 3. Incomplete or complete pure rupture of the prostatomembranous junction, supradiaphragmatic. Type 4. Incomplete or complete rupture of the bulbomembranous urethra, infradiaphragmatic. Type 5. Variable combined urethral injuries affecting more than one level of the urethra, prostatic and membranous or prostatomembranous and bulbomembranous, injury to proximal sphincteric mechanism combined with prostatic and/or membranous urethral injury. CONCLUSIONS: This anatomical and functional classification includes all types of urethral injuries secondary to pelvic fracture; moreover, it directs the attention towards evaluation of the urethral sphincteric mechanism, which is essential for the therapeutic and medicolegal aspects.
OBJECTIVE: To develop a new functional and anatomical classification of urethral injury secondary to pelvic fracture. MATERIAL AND METHODS: Fifty-six male patients (20 children, 36 adults) with urethral injuries secondary to pelvis fracture were evaluated. Clinical examination, retrograde urethrogram immediately after the accident, operative findings in the emergency state, subsequent combined retrograde urethrography and suprapubic cystography, operative findings during urethral reconstruction and postoperative follow-up were critically reviewed retrospectively. RESULTS: A new classification of urethral injury secondary to pelvic fracture is proposed as a result of our findings: Type 1. Injury to the prostate; 1a. Proximal avulsion of the prostate; 1b. Incomplete or complete trans-prostatic rupture. Type 2. Stretching of the membranous urethra. Type 3. Incomplete or complete pure rupture of the prostatomembranous junction, supradiaphragmatic. Type 4. Incomplete or complete rupture of the bulbomembranous urethra, infradiaphragmatic. Type 5. Variable combined urethral injuries affecting more than one level of the urethra, prostatic and membranous or prostatomembranous and bulbomembranous, injury to proximal sphincteric mechanism combined with prostatic and/or membranous urethral injury. CONCLUSIONS: This anatomical and functional classification includes all types of urethral injuries secondary to pelvic fracture; moreover, it directs the attention towards evaluation of the urethral sphincteric mechanism, which is essential for the therapeutic and medicolegal aspects.
Authors: B Padilla-Fernandez; F J Diaz-Alferez; M A Garcia-Garcia; M Herrero-Polo; J F Velasquez-Saldarriaga; M F Lorenzo-Gomez Journal: Clin Med Insights Case Rep Date: 2012-09-24