Pelvic Fracture Urethral Injury in Females
Abstract
Background: Pelvic fracture urethral injuries (PFUI) in females are very rare. The available literature on the
management of this condition is scarce and not clear, mainly because of limited experience among reconstructive
surgeons. We present our experience of management of these complex urethral injuries in female patients.
Materials and Methods: We collected data, retrospectively and prospectively for 22 female patients referred
to our center for PFUI repair between 1995 and 2021. During the clinical assessment of these complex injuries,
following our internal institutional protocol, all patients underwent pelvic MRI (bladder and urethra are filled
with saline solution and jelly to enhance the urethral lumen and the level of the distraction) before anastomotic
urethroplasty.
Results: PFUI compromised the mid urethra in 10 patients (45.5%). A transabdominal approach was used in
8 patients (80%), and urethra-vaginal fistula repair was undertaken in 6 patients (60%). After a median follow-up of
36 months, only 1 patient with proximal PFUI required a surgical revision without compromising urinary continence.
Conclusions: The most common site of urethral involvement in pelvic fracture is mid urethral, which is owing
to avulsion. Urethra-vaginal fistula should be suspected. Treatment consists in anastomotic urethroplasty, mainly
through the abdominal approach.
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