骨盆骨折引起之下泌尿道損傷的診斷方法與預後：聚焦在電導斷層之角色
楊聿寬¹、王大民¹、傅志遠²、鄭有森²

¹林口長庚紀念醫院 外科部 泌尿科; ²林口長庚紀念醫院 外科部 外傷急症外科

Outcomes and Diagnostic Approaches in Lower Urinary Tract Injuries from Pelvic Fractures: A Focus on CT Imaging

Yu-Kuan Yang¹, Ta-Ming Wang¹, Chih-Yuan Fu², Yu-San Tee²

Division of ¹Urology, and ²Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

Introduction:
High-energy pelvic fractures are frequently linked with lower urinary tract injuries (LUTIs) in approximately 10-15% of cases, which can lead to significant morbidity if not promptly diagnosed. Bladder and urethral injuries can cause infections, urinary obstructions, and long-term complications. Diagnosing LUTIs in hemodynamically unstable patients is challenging and often requires retrograde cystography, CT cystography, and retrograde urethrography (RUG). This study evaluates a 13-year experience with LUTIs associated with pelvic fractures, with a particular focus on the role of CT imaging in diagnosis.
Materials and Methods:

We performed a retrospective analysis of pelvic fracture cases with hematuria managed at a tertiary medical center from 2009 to 2021. All patients underwent abdominal and pelvic CT imaging upon arrival. Demographic information, injury details, Injury Severity Scores (ISS), diagnostic techniques, and infection rates were collected. We compared patients with bladder injuries to those with urethral injuries, focusing on timing of diagnosis and clinical outcomes.
Results:
Of the 2,865 patients with pelvic fractures, 127 (4.4%) were found to have LUTIs. The median patient age was 36 years, with 76% being male, and a median ISS of 26. Bladder injuries were present in 54% of cases with LUTI, urethral injuries in 40%, and both injuries in 6%. CT was more effective in detecting bladder injuries (58%) compared to urethral injuries (20%). Patients diagnosed by CT in the emergency department had lower infection rates and required fewer additional urological imaging studies. Thirteen patients (10%) had delayed diagnoses, largely due to a primary focus on life-saving measures initially. No significant difference in outcomes was found between early and delayed diagnosis.

Conclusion:

CT imaging is an important tool for the initial assessment of suspected LUTIs in pelvic fracture patients, minimizing the need for invasive diagnostic methods and enabling timely diagnosis. Delayed LUTI diagnoses did not adversely impact outcomes, particularly when made within two weeks. Future research should aim to enhance protocols for early identification in emergency settings, where comprehensive urological assessments may not always be feasible.