Lower urinary tract imaging in pelvic fracture: an 11-year review of genitourinary complications and clinical outcomes.

BACKGROUND: Diagnostic cysto-urethrogram (CUG) is accepted as the standard of imaging for lower urinary tract (LUT) injuries in patients with pelvic fracture. This study evaluates the prevalence of LUT trauma and adequacy of diagnostic CUG in the initial assessment of patients with pelvic fractures.

METHODS: A retrospective review on all patients admitted with pelvic trauma between 2002 and 2012 was undertaken following ethics approval. Patient demographics such as pelvic fracture pattern, genitourinary injury, diagnostic imaging tests and clinical outcomes were reviewed.

RESULTS: A total of 99 patients were identified during the 11 years. Nine patients were excluded due to prior LUT imaging at another hospital. Of the 90 patients, macroscopic haematuria was present in 63 patients (70%), and LUT injury was diagnosed in 42 patients (46.6%). LUT imaging was performed in 30 patients (33.3%) - four patients with urethrogram alone, 17 had cystogram alone and nine patients underwent CUG. An oblique view was included in five of 20 studies (25%) performed with direct fluoroscopy. Adequate bladder filling was present in 17 of 26 bladder imaging studies (65.3%). LUT injury was missed in seven of 90 patients (7.8%) due to the absence of imaging. This consisted of one patient with urethral injury and six patients with bladder injury, all of whom experienced delays in treatment. Long-term genitourinary dysfunction was present in three of seven patients with delayed diagnosis.

CONCLUSION: Incomplete CUG in the assessment of pelvic fracture can result in treatment delay and genitourinary dysfunction.