Challenges in the Diagnosis of Pelvic Fracture-Related Lower Urinary Tract Injury: A 13-Year Retrospective Analysis

Introduction : Pelvic fractures from high-energy trauma are associated with lower urinary tract injuries (LUTI) in 10-15% of cases, leading to significant morbidity if not promptly diagnosed. Bladder and urethral injuries can result in infection, urinary obstruction, and long-term complications. However, diagnosing LUTI in hemodynamically unstable patients remains challenging, often requiring a combination of retrograde cystography, computed tomography (CT) cystography, and retrograde urethrography (RUG). This study reviews 13 years of clinical experience with pelvic fracture-related LUTI, focusing on the diagnostic role of CT imaging. Materials and Methods : We retrospectively analyzed pelvic fracture cases with hematuria at a tertiary center from 2009 to 2021. All patients received abdominal and pelvic CT scans on admission. We recorded demographic data, injury characteristics, Injury Severity Score (ISS), diagnostic methods, and infection rates. Comparisons were made between patients with bladder and urethral injuries, and between patients with initial positive and negative CT findings of LUTI. Additionally, the clinical characteristics of delayed LUTI diagnosis in patients with severe trauma were summarized Results : Of 2,865 patients with pelvic fractures, 127 (4.4%) were diagnosed with LUTI. The median age was 36 years, and 76% were male, with a median ISS of 26. Bladder injuries were present in 54% of LUTI cases, urethral injuries in 40%, and combined injuries in 6%. Diagnosis via CT was significantly higher for bladder injuries (58%) than urethral injuries (20%). Among those diagnosed with CT in the emergency department, infection rates and need for further urological imaging were lower. Thirteen patients (10%) had delayed diagnoses, primarily due to initial focus on life-saving interventions. No significant difference in outcomes was noted between early and delayed diagnoses. Conclusion : CT imaging is valuable for the initial evaluation of pelvic fractures with suspected LUTI, reducing the need for invasive diagnostic studies and aiding early diagnosis. Delays in LUTI diagnosis did not significantly impact outcomes, especially when diagnosis was made within two weeks. Future studies should focus on refining guidelines for early diagnosis in emergency settings where comprehensive urological assessments may be limited.