Niels V Johnsen1, Roger R Dmochowski2, Jason B Young3, Oscar D Guillamondegui3. 1. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: niels.v.johnsen@vanderbilt.edu. 2. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. 3. Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN.
Abstract
OBJECTIVE: To assess the contemporary epidemiology of blunt trauma lower urinary tract injury (LUTI) and to evaluate outcomes in patients with and without associated pelvic fracture (PF). METHODS: Patients presenting to our level I trauma center with PF and/or LUTI from blunt trauma from 2000 to 2014 were identified in our institutional trauma registry. Demographics, mechanism of injury, fracture configurations, hospital course, and outpatient disposition were analyzed. RESULTS: Of 5518 PF patients, 233 (4.2%) had LUTI. Thirty-four patients had non-PF LUTI. There were 3.2% of men and 3.3% of women with PF who had bladder injuries (P = .94). Urethral injury was more common in men (2.0% vs 0.05%; relative risk 43.1). Pubic arch fractures were present in 87% of patients with urethral injuries, although only 1.5% of patients with pubic arch fractures had urethral injury. Isolated acetabular fractures were never associated with urethral injury and associated with only 2.6% of bladder injuries. Extraperitoneal bladder ruptures were more common in the PF group as compared to the non-PF LUTI group (39.1% vs 14.7%, P < .01). Intensive care unit length of stay and hospital length of stay for PF vs non-PF patients were 7.1 ± 8.1 vs 2.8 ± 5.3 days (P < .01) and 13.5 ± 13.4 vs 7.7 ± 8.4 days (P = .01), respectively. CONCLUSION: These data suggest that the contemporary incidence of PF LUTI is lower than previously reported. The presence of PF in patients with LUTI is associated with more severe overall injuries, longer hospital stays, and increased rates of inpatient complications.
OBJECTIVE: To assess the contemporary epidemiology of blunt trauma lower urinary tract injury (LUTI) and to evaluate outcomes in patients with and without associated pelvic fracture (PF). METHODS:Patients presenting to our level I trauma center with PF and/or LUTI from blunt trauma from 2000 to 2014 were identified in our institutional trauma registry. Demographics, mechanism of injury, fracture configurations, hospital course, and outpatient disposition were analyzed. RESULTS: Of 5518 PFpatients, 233 (4.2%) had LUTI. Thirty-four patients had non-PF LUTI. There were 3.2% of men and 3.3% of women with PF who had bladder injuries (P = .94). Urethral injury was more common in men (2.0% vs 0.05%; relative risk 43.1). Pubic arch fractures were present in 87% of patients with urethral injuries, although only 1.5% of patients with pubic arch fractures had urethral injury. Isolated acetabular fractures were never associated with urethral injury and associated with only 2.6% of bladder injuries. Extraperitoneal bladder ruptures were more common in the PF group as compared to the non-PF LUTI group (39.1% vs 14.7%, P < .01). Intensive care unit length of stay and hospital length of stay for PF vs non-PFpatients were 7.1 ± 8.1 vs 2.8 ± 5.3 days (P < .01) and 13.5 ± 13.4 vs 7.7 ± 8.4 days (P = .01), respectively. CONCLUSION: These data suggest that the contemporary incidence of PF LUTI is lower than previously reported. The presence of PF in patients with LUTI is associated with more severe overall injuries, longer hospital stays, and increased rates of inpatient complications.
Authors: Ross E Anderson; Sorena Keihani; Rachel A Moses; Alexander P Nocera; J Patrick Selph; Clara M Castillejo Becerra; Nima Baradaran; Katie Glavin; Joshua A Broghammer; Chirag S Arya; Rachel L Sensenig; Michael E Rezaee; Bradley J Morris; Sarah Majercik; Timothy Hewitt; Frank N Burks; Ian Schwartz; Sean P Elliott; Xian Luo-Owen; Kaushik Mukherjee; Peter B Thomsen; Bradley A Erickson; Brandi D Miller; Richard A Santucci; LaDonna Allen; Scott Norwood; Cameron N Fick; Brian P Smith; Joshua Piotrowski; Christopher M Dodgion; Erik S DeSoucy; Scott Zakaluzny; Dennis Y Kim; Benjamin N Breyer; Barbara U Okafor; Reza Askari; Jacob W Lucas; Jay Simhan; Seyyed Saeed Khabiri; Raminder Nirula; Jeremy B Myers Journal: J Urol Date: 2020-04-07 Impact factor: 7.450
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