Urethral injuries in female subjects following pelvic fractures.
Pelvic fractures resulting from high speed motor vehicle and/or pedestrian-motor vehicle accidents commonly coexist with urethral injuries in the male patient. A review of 130 female patients with pelvic fractures managed at our institution revealed coexisting urethral injuries in 6 (4.6%). Partial urethral disruptions accounted for the majority of morbidity with early removal of the Foley catheter resulting in urinary extravasation, voiding difficulties and vulvar edema. In 3 patients the injury was misdiagnosed, 2 of whom had life-threatening sepsis with necrotizing fascitis as a consequence. Blood at the vaginal introitus was noted in more than 80% of our patients. However, only half of them had a careful vaginal inspection. If this pertinent portion of the physical examination had been performed more than two-thirds of our patients could have been correctly diagnosed. The need for meticulous vaginal examination when blood is located at the vaginal introitus, and the need for careful cystoscopic and/or radiographic evaluations in the female patient with voiding difficulties and/or vulvar edema in the acute post-traumatic phase are stressed.
Perry
M O
MO
Division of Urology, University of Texas Southwestern Medical Center, Dallas.
Husmann
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DA
D000063:Accidents, Traffic; D000328:Adult; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D014521:Urethra / Q000293:injuries* / Q000473:pathology; D001743:Urinary Bladder / Q000293:injuries / Q000473:pathology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000473:pathology