title: The incidence, causes, mechanism, risk factors, classification, and diagnosis of pelvic fracture urethral injury.
abstract: BACKGROUND
  Pelvic fracture urethral injury (PFUI) is an uncommon but potentially devastating result of pelvic fracture. It ranges in severity based on the cause and the mechanism of injury.
  
  
  METHODS
  We reviewed previous reports to identify the incidence, causes, mechanisms of injury and risk factors of PFUI. In addition, we reviewed the current classification systems and diagnostic methods that have been described to assess the severity of PFUI, to identify optimal management strategies and evaluate outcomes.
  
  
  RESULTS
  PFUI occurs more commonly in men, but is more likely to be severe in children. The most common cause is motor vehicle collisions, and the mechanism is typically a ligament rupture at the attachment to the urethra. There is no reliable classification system to differentiate partial and complete PFUI. Retrograde urethrography is the standard imaging method but it has its limitations.
  
  
  CONCLUSIONS
  Despite many reports describing this injury, there is still a need to further clarify the incidence, aetiology and mechanism of injury to better determine optimal management strategies and evaluate outcomes. Consensus in the diagnosis of PFUI is lacking, and outcomes of primary realignment and the role of flexible cystoscopy as a diagnostic method are still to be determined.
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA ; King Abdul Aziz University, Jeddah, Saudi Arabia.
authors.forename: Amjad
authors.initials: A
authors.lastname: Alwaal
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Uwais B
authors.initials: UB
authors.lastname: Zaid
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Blaschko
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Harris
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Gaither
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Jack W
authors.initials: JW
authors.lastname: McAninch
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
keywords: BN, bladder neck; Classification; Diagnosis; MVC, motor vehicle collision; PFUDD, pelvic fracture urethral distraction defect; PFUI, pelvic fracture urethral injury; Pelvic fracture; RUG, retrograde urethrography; Urethral injury