A. M. Bales1, K. F. Purcell1, J. Ferrauiola1, R. J. Markert1, A. P. Ekeh1, G. Semon1, D. Kimpel1, M. Prayson1, M. C. McCarthy1 1Wright State University,Boonshoft School Of Medicine,Dayton, OH, USA
Introduction:
Blunt pelvic fracture is the most common mechanism of injury to the urogenital system. Intraperitoneal bladder injuries undergo prompt surgical repair, while extraperitoneal injuries are managed with Foley catheter drainage until healed. However, when pelvic fixation is performed in the retropubic space, the bladder injury plane is violated and the injury may be exacerbated. Whether it is beneficial to repair extraperitoneal bladder rupture at the time of pelvic fixation remains uncertain.
Methods:
All trauma patients over a 15-year period at a Level 1 Trauma Center with a lower genitourinary tract injury and pelvic fracture were identified. Trauma registry and chart reviews were performed; 31 patients with combined pelvic fracture and extraperitoneal bladder rupture were identified. Sequential treatment strategies were mapped to determine optimal management of these injuries.
Results:
The 31 patients included 14 women and 17 men, with mean age of 39.23 ± 18.3 years, and injury severity scores of 26.8 ± 10.1. Twenty-five cases involved motor vehicles, and 2 patients died. Overall 4/10 (40%) of the repaired extraperitoneal bladder ruptures leaked and 8/21 (38.1%) of those managed by drainage alone leaked. Analysis of variables showed higher leak rates associated with open book fractures, anterior pelvic repairs, AAST bladder classifications ≥3, and higher injury severity scores.
Conclusion:
Concurrent operative repair of the extraperitoneal bladder rupture and pelvic fracture did not result in a decrease in bladder leak on follow up cystogram. Multi-institutional studies are needed to solidify variables predictive of postoperative bladder leakage and optimal treatment strategies for this challenging combination of injuries.