A 10 year review of the management of bladder injury associated with pelvic fracture at a Major Trauma Centre.
BAUS ePoster online library. Bottrell O. 06/26/19; 259500; P13-6
Mr. Oliver Bottrell
Mr. Oliver Bottrell
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Abstract
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INTRODUCTION:

This study reviews the management of bladder injury associated with pelvic fracture at a major trauma centre with a long standing tertiary referral practice for the management of pelvic fractures.

Patients and Methods:

Patients were identified from our internal, and the Trauma Audit & Research Network database. Outcomes analysed included management, associated urological injury, cystography and urological complications.

Results:

43 patients were identified (26 extraperitoneal, 9 intraperitoneal or combined, 4 haematoma, 4 unclassified). Mechanisms were road traffic accident (RTA) (51.2%), RTA pedestrian (18.6%), fall (23.2%), and crush injury (7.0%). Referrals included 36 direct or local transfers and 7 overseas repatriations. Of those with extraperitoneal injury 13 underwent open cystorraphy and 13 were managed with a catheter. All 13 extraperitoneal cystorraphies were performed at the same time as non-urological surgery. 6 of the catheter managed extraperitoneal injuries also underwent open pelvic or abdominal non-urological surgery. We observed a higher rate of leak at follow-up cystography (55.6% vs. 11.1%) in patients with extraperitoneal injury who were managed with a catheter vs. cystorraphy (p = 0.13). Across all injury types a higher rate of urological complication (80% vs. 29.4%) was observed when associated with urethral injury (p = 0.047).

Conclusions:

The demographic data is consistent with most series. There was however a higher percentage of patients undergoing open cystorraphy in the management of extraperitoneal bladder injury related to the move towards early open reduction and internal fixation of pelvic fractures. Multidisciplinary team working is essential to establish best practice.
INTRODUCTION:

This study reviews the management of bladder injury associated with pelvic fracture at a major trauma centre with a long standing tertiary referral practice for the management of pelvic fractures.

Patients and Methods:

Patients were identified from our internal, and the Trauma Audit & Research Network database. Outcomes analysed included management, associated urological injury, cystography and urological complications.

Results:

43 patients were identified (26 extraperitoneal, 9 intraperitoneal or combined, 4 haematoma, 4 unclassified). Mechanisms were road traffic accident (RTA) (51.2%), RTA pedestrian (18.6%), fall (23.2%), and crush injury (7.0%). Referrals included 36 direct or local transfers and 7 overseas repatriations. Of those with extraperitoneal injury 13 underwent open cystorraphy and 13 were managed with a catheter. All 13 extraperitoneal cystorraphies were performed at the same time as non-urological surgery. 6 of the catheter managed extraperitoneal injuries also underwent open pelvic or abdominal non-urological surgery. We observed a higher rate of leak at follow-up cystography (55.6% vs. 11.1%) in patients with extraperitoneal injury who were managed with a catheter vs. cystorraphy (p = 0.13). Across all injury types a higher rate of urological complication (80% vs. 29.4%) was observed when associated with urethral injury (p = 0.047).

Conclusions:

The demographic data is consistent with most series. There was however a higher percentage of patients undergoing open cystorraphy in the management of extraperitoneal bladder injury related to the move towards early open reduction and internal fixation of pelvic fractures. Multidisciplinary team working is essential to establish best practice.
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