MP04-08 BLUNT TRAUMATIC FEMALE URETHRAL AND BLADDER NECK INJURIES: A 15 YEAR SINGLE-INSTITUTION EXPERIENCE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-08 BLUNT TRAUMATIC FEMALE URETHRAL AND BLADDER NECK INJURIES: A 15 YEAR SINGLE-INSTITUTION EXPERIENCE Catalina K. Hwang, Stanley Moore, Ziho Lee, and Judith C. Hagedorn Catalina K. HwangCatalina K. Hwang More articles by this author , Stanley MooreStanley Moore More articles by this author , Ziho LeeZiho Lee More articles by this author , and Judith C. HagedornJudith C. Hagedorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Injury of the female urethra and bladder neck (BN) from blunt trauma is rare. Our understanding of its management and outcomes is based on case reports predominantly in the pediatric population, which describe high complication rates related to delayed management. We present our 15-year experience of this injury in an adult population. METHODS: We retrospectively reviewed records of all female patients admitted to our Level 1 trauma center from 2005 to 2019 with a urethral or BN injury. All inpatient and outpatient records were reviewed. RESULTS: Ten patients were identified with a median age of 36.5 (range 17-48) years. All patients had concomitant pelvic fractures. Six injuries involved the BN, 3 the proximal urethra, and 1 the distal urethra. All injuries were confirmed operatively. Median time to diagnosis was 1 (range 0-4) day after presentation. Gross hematuria was seen in all patients. Of 6 patients with preoperative CT cystogram, 50% had a scan that demonstrated the injury. Of 8 patients with pre-operative pelvic examination, 50% had an identifiable injury on that exam. Cystoscopy in the operating room was performed in 4 patients. Visual inspection of the urethra through cystotomy was performed in 5 patients. There were no delayed or missed diagnoses. Two patients were lost to follow-up. One patient was not eligible for early repair of urethral injury due to clinical instability and underwent urethrovaginal fistula repairs at 3 months, and at 18 months after presentation. Of the 7 remaining patients who underwent early management of their injury within 7 days, 2 (29%) had a major surgical complication (Clavien grade >2) including pyelonephritis and suprapubic wound abscess. One patient had a urethrovaginal fistula that was seen on voiding cystourethrogram with spontaneous resolution of pneumaturia. On median follow-up of 15.2 (range 3-19.5) months, none of these patients who underwent early management reported long-term Urologic concerns related to urethral injury, including stricture and incontinence. CONCLUSIONS: Our experience suggests that intraoperative evaluation is the only reliable diagnostic modality for urethral and BN injury in adult females. Although some patients had early surgical complications, none of those who underwent prompt management within 7 days of injury had long-term complications of their urethral injury. Our excellent outcomes reinforce the importance of an aggressive diagnostic strategy and surgical repair for female urethral and BN injury. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e70-e70 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catalina K. Hwang More articles by this author Stanley Moore More articles by this author Ziho Lee More articles by this author Judith C. Hagedorn More articles by this author Expand All Advertisement PDF downloadLoading ...