European Journal of Molecular & Clinical Medicine

Abstract

Background: Trauma is non-discriminatory and affects in all age group. Injuries to the urinary bladder (60-90%) and posterior urethra (75%) are mainly associated with pelvic fractures. Urethral injuries from pelvic fracture are typically associated with multiple organ injuries (bladder, spleen, liver, and bowel). The bulbar urethra is most commonly injured by a straddle injury iatrogenic injuries to the urethra occur when difficult urethral catheterization leads to mucosal injury with subsequent scarring and stricture formation. Urological injuries have been inescapably associated with gynecological and obstetrical surgeries, owing to anatomic proximities of urogenital organs.
Methods: This prospective study was carried out from May 2018 to June 2021 at government medical college and hospital, Aurangabad. All patients presenting with trauma either blunt or penetrating or iatrogenic who were admitted to emergency care unit or who were admitted to inpatient department as per hospital protocol were screened and evaluated, out of this those patients who were diagnosed to have lower urinary tract trauma on clinical and radiological findings were enrolled in the present study. The cases suffering trauma to the lower urinary tract during the procedures like abdominal hysterectomy, lower segment caesarean section surgeries were also included in the study.
Results: 58.3% patients of bladder injury, 44.4% urethral injury and 50% of ureteral injury were in the age group 21-30 years. The male to female ratio was 2.38:1 showing male preponderance. Gross hematuria was most common presenting symptom in 50% of total cases especially urinary bladder (70.8%) followed by difficulty in micturition 31.8%, and suprapubic tenderness 27.3%. Blunt trauma to abdomen was the commonest cause of lower urinary tract reported in 59.1% of total cases.
Conclusion: Lower urinary tract trauma is a specialized injury that can have significant sequelae if left untreated. Recognizing and treating these injuries can be difficult in the multi-trauma patient. In general, when the index of suspicion is high, retrograde imaging should be attempted whenever possible. Expert urological opinion should be sought early and the safest method of urinary diversion within the experience of the clinician should be attempted.