A Personal View of the Immediate Management of Pelvic Fracture Urethral Injuries

Abstract

1. The best treatment for all but the most severe urethral injuries associated with pelvic fractures must surely be suprapubic catheter drainage without local exploration. 2. The free drainage of exudates from an injured urethra is be obstructed by the larger sizes of standard-shaft indwelling catheter; the use of a standard shaft catheter in an injured urethra requires careful consideration in relation to the individual problem and should not be a routine; however, a fenestrated catheter may have some positive advantages. 3. The results of treating the less severe fracture-dislocation injuries by suprapubic catheter are sufficiently good to make any attempt at immediate local readjustment of incomplete dislocations inadvisable for all but those with a special experience of the surgery of the traumatized urethra. 4. If abdominopelvic exploration has to be undertaken for non-urologic indications, the repositioning of a dislocated bladder base by the aligned sling-suture technique is a relatively simple procedure which can be swiftly and reliably accomplished by an emergency surgeon. 5. The treatment of a urethral injury, even if severely dislocated, is not in itself a matter of immediate urgency once suprapubic catheter drainage has been established; however, exploration for continued bleeding may be. If bleeding is controlled by local tamponade there may be considerable advantage in postponing definitive resolution of a massive urethral dislocation for a week or so because the patient is usually fitter and the procedure is less likely to be complicated by serious hemorrhage. When a particular urethral injury is considered suitable for a delayed primary repositioning, the patient may be fit enough to transfer to the care of a urologic department with special experience of these problems.