Urinary Tract Lesions Research Articles

Urine microbiota in non-muscle-invasive bladder cancer and approaches to its detection

Introduction. There is evidence of a connection between infectious and inflammatory lesions of the lower urinary tract and bladder cancer (BCa). However, there is virtually no data on the urine microbiota of middle-aged and elderly men with suspected BCa. This knowledge is extremely important from the point of view of studying the role of the infectious-inflammatory hypothesis in the genesis of BCa.Objective. To conduct a comparative assessment of the microbiota of bladder urine obtained during natural urination and bladder catheterization through standard and extended cultural studies in men with a presumptive diagnosis of non-muscle-invasive bladder cancer (NMIBC).Materials & methods. The prospective comparative study with consecutive patient recruitment included 23 men older than 45 years with suspected NMIBC based on clinical, laboratory and sonographic data, as well as with no history of infectious and inflammatory diseases of the kidneys and urinary tract, including sexually transmitted infections and recurrent infections of other organs and systems. A midstream urine samples and catheter-drained urine immediately before urethrocystoscopy were subjected to bacteriological analysis. Urine culture study was carried out using a standard set of nutrient media under aerobic cultivation conditions and an expanded set of nutrient media under aerobic and anaerobic cultivation conditions.Results. An anaerobic spectrum of microorganisms was predominantly detected in the urine of patients with suspected NMIBC. Moreover, Peptococcus spp. was more often found among anaerobic taxa. (70%), Eubacterium spp., Propionibacterium spp. (45% each, respectively), among representatives of the aerobes — Corynebacterium spp. (60%), S. lentus (up to 45%), S. haemolyticus (35%) and E. faecalis (30%). Data from a comparative analysis of the detection frequencies of microorganisms depending on the method of collecting material and the set of media for cultivation showed that more isolates are isolated in the midstream urine samples than in the study of catheter urine (2.9- and 1.9-fold with the standard and extended sets of media, respectively). In addition, when performing an extended bacteriological study compared to the standard method, the detection of microorganisms is 3.5-fold higher when examining an average portion of urine and 5.1-fold higher when examining catheter urine. The average number of microorganisms per one patient is also higher when using the extended method (midstream portion — 4.7 ± 1.9; catheterised urine — 2.3 ± 1.0) in comparison with the standard one (midstream portion — 1.3 ± 0.9; catheterised urine — 0.3 ± 0.5).Conclusion. Middle-aged and older men with NMIBC are characterized by asymptomatic bacteriuria in the form of a wide range of aerobic and anaerobic microorganisms. The urine pattern obtained with a urethral catheter contains a significantly narrower range of bacteria compared to the sample obtained through natural urination. It is advisable to carry out an extended cultural urine examination to study the characteristics of the microbiota / microbiome of the urine of the bladder immediately before the urethrocystoscopy procedure by collecting urine with a urethral catheter.

Benign and Non-Neoplastic Urinary Tract Lesions

Urine cytology includes multiple benign and non-neoplastic conditions that may mimic urothelial carcinoma. It is important to recognize and to not overcall these to avoid unnecessary procedures and treatment. In this article we review reactive cytological changes of urine secondary to infections, inflammatory conditions, as well as the most common benign proliferations and therapy-related changes.

Cytology of the Urinary Tract: Specimen Sampling, Preparation, Adequacy, and Normal Cellular Components

Urine evaluation is one of the oldest tests used in ancient medicine. Cytologic examination of urine is a simple, non-invasive, cost effective, and reliable method to uncover a wide variety of reactive and neoplastic processes in urothelium. Urinary tract lesions are often multifocal, may be inapparent on cystoscopic examination or inaccessible to directly biopsy. Thus, urine cytology remains one of the most common methods for the initial diagnosis of urothelial carcinoma that may be manageable with early detection. In this article we review indications for urine cytology, sampling techniques, preparatory methods, adequacy, and elements of normal urine.

Retroperitoneal biloma—A rare differential diagnosis of perirenal fluid accumulation

IntroductionNontraumatic biliary rupture and retroperitoneal biloma infrequently occur. Here, we report a case of retroperitoneal biloma due to spontaneous left hepatic duct perforation, which was difficult to differentiate from a perirenal abscess.Case presentationA 94‐year‐old female patient was hospitalized with symptoms of fatigue and right back pain that lasted for 5 days. Computed tomography revealed fluid accumulation in the retroperitoneum, and urinary extravasation and right perinephric abscess were suspected. Antimicrobial treatment and drainage with ureteral stents and urethral catheters demonstrated no symptom improvement. Ultrasound‐guided puncture of the abscess revealed the presence of bile. Pigtail catheter drainage improved symptoms and inflammatory response. After diagnosis, endoscopic retrograde cholangiopancreatography revealed bile leakage, and a bile duct stent was inserted.ConclusionBiloma can cause perirenal fluid accumulation, and they should be considered an origin of perirenal fluid accumulation when urinary tract lesions are excluded.

Urine cytology in the detection of renal cell carcinomas - a territory-wide multi-institutional retrospective review of more than 2 decades.

Compared with urothelial lesions of the upper urinary tract, the diagnostic performance of urine cytology in detection of renal cell carcinomas is underreported. This study aims to establish the role of urine cytology in the assessment of renal carcinomas by a multi-institute review of urine cytology from nephrectomy confirmed renal cell carcinomas, referenced against renal urothelial and squamous cell carcinomas. Records of nephrectomy performed from the 1990s to 2020s at three hospitals were retrieved and matched to urine cytology specimens collected within 1year prior. Patient demographics, specimen descriptors, and histology and staging parameters were reviewed and compared against cytologic diagnoses. There were 1147 cases of urine cytology matched with renal cell carcinomas, with 666 renal urothelial/squamous carcinomas for comparison. The detection rate for urothelial/squamous (atypia or above [C3+]: 63.1%; suspicious or above [C4+]: 24.0%) were higher than renal cell carcinoma (C3+: 13.1%; C4+: 1.5%) (p<0.001). The positive rate for upper tract urine exceeded other collection methods at 45.0% (C3+) and 10.0% (C4+) (p<.01). Other factors associated with increased positive rates were male sex, collecting duct carcinoma histology, nuclear grade, and renal/sinus involvement (p<.05). Multivariate analysis revealed additional positive correlations with presence of sarcomatoid tumor cells, lymphovascular invasion, and perinephric fat involvement (p<.05). Larger lesion size and higher urine volume did not improve detection rates (p<.05). The detection rate of renal cell carcinomas is suboptimal compared with urothelial carcinomas, although urine samples collected from cystoscopy or percutaneous nephrostomy significantly outperformed voided urine specimens.

Diagnostic Approach to and Differential Diagnosis of Clear Cell and Glandular Lesions of the Lower Urinary Tract.

A variety of glandular and clear cell lesions may be seen in the urinary bladder and/or urethra, ranging from benign to malignant primary and secondary tumors. Lesions with no malignant potential include reactive processes, such as nephrogenic metaplasia, and may show similar morphologic features as an infiltrative neoplasm, particularly in small biopsies. Similarly, ectopic tissues of Müllerian origin may be seen in the lower urinary tract, and their distinction from a true glandular neoplasm is essential to avoid overtreatment. A wide variety of primary and secondary malignant tumors exist with varying degrees of glandular and clear cell features. Therefore, surgical pathologists must be aware of the full scope of possible lesions to avoid misdiagnosis. To provide a practical framework for approaching the diagnosis of clear cell and glandular lesions of the urinary bladder/urethra and prostate, highlighting the strengths and limitations of various diagnostic features and ancillary tests. A review of the current literature was performed to obtain data regarding up-to-date diagnostic features and ancillary studies. In summary, distinct morphologic and immunohistochemical features and clinical and radiologic correlation are essential to establish an accurate diagnosis when such cases with glandular and clear features are encountered in the lower urinary tract.

Urological knowledge and tools applied to diagnosis and surgery in deep infiltrating endometriosis - a narrative review.

This review discusses deep infiltrating endometriosis (DIE) diagnosis and surgery using current urological knowledge and technologies. Narrative review of deep infiltrating endometriosis that result in urological issues. We examined manuscripts from Pubmed, Embase, and Scielo's database using the following MeSH terms: ('endometriosis') AND ('urology' OR 'urological' OR 'urologist') AND ('bladder' OR'vesical') AND ('ureteral' OR 'ureter').Selection followed PRISMA guidelines. Sample images from our records were brought to endorse the findings. Thirty four related articles were chosen from 105. DIE may affect the urinary system in 52.6% of patients. Lower urinary tract symptoms may require urodynamic examination. Ultrasonography offers strong statistical yields for detecting urinary tract lesions or distortions, but magnetic resonance will confirm the diagnosis. Cystoscopy can detect active lesions, although any macroscopic visual appeal is pathognomonic. Endourology is utilized intraoperatively for bladder and ureteral assessment, however transurethral endoscopic excision of bladder lesions had higher recurrence rates. Laparoscopy is the route of choice for treatment; partial cystectomy, and bladder shaving were the most prevalent surgical treatments for bladder endometriosis. Regarding the ureteral treatment, the simple ureterolysis and complex reconstructive techniques were described in most papers. Using anatomical landmarks or neuronavigation, pelvic surgical systematization allows intraoperative neural structure identification. DIE in the urinary system is common, however the number of publications with high level of evidence is limited. The initial tools for diagnosis are ultrasonography and cystoscopy, but magnetic resonance is the most reliable tool. When the patient has voiding symptoms, the urodynamic examination is crucial. Laparoscopy improves lesion detection and anatomical understanding. This approach must be carried out by professionals with high expertise, since the surgery goes beyond the resection of lesions and includes the preservation of nerve structures and urinary tract reconstruction techniques.

Lipoma of Renal Pelvis, Case Report of a Rare Upper Urinary Tract Tumor

Abstract Background: We report an exceptionally rare case, documenting the diagnosis and treatment of a lipoma of the renal pelvis in a 66-year-old White woman. This case represents the second reported lipoma in the upper urinary tract. Case Summary: An incidentally found filling defect in the right renal pelvis identified on CT scan in a 66-year-old woman resulted in referral to urology. Ureteroscopy was used to visualize, biopsy, and remove the tumor, with complete sparing of the kidney and associated structures. Histological analysis of the lesion revealed a benign tumor of mature adipocytes. The patient has been monitored for over 15 months postoperatively with no evidence of recurrence. Conclusions: This case serves as a reminder that many different nonmalignant lesions may be found throughout the upper urinary tract. It also highlights the kidney-sparing benefits of using ureteroscopic approaches whenever feasible in the timely diagnosis and treatment of upper urinary tract lesions.

The use of the double uterine segment tourniquet in obstetric hysterectomy for bleeding control in patients with placenta accreta spectrum.

To evaluate surgical outcomes of using a double uterine segment tourniquet in obstetric hysterectomy for bleeding control in patients with placenta accreta spectrum. Retrospective case-control study conducted at the Central Hospital of San Luis Potosi, Mexico. Patients with the diagnosis of placenta accreta spectrum who underwent obstetric hysterectomy were included. Two groups were formed: in the first, a double uterine segment tourniquet was used; and in the second, the hysterectomy was performed without a tourniquet. Primary surgical outcomes were compared. Forty patients in each group were included. The use of a double uterine segment tourniquet had lower total blood loss compared with the non-tourniquet group (1054.00 ± 467.02 vs. 1528.75 ± 347.12 mL, P= 0.0171) and a lower drop in hemoglobin (1.74 ± 1.10 vs. 2.60 ± 1.25 mg/dL, P= 0.0486). Ten patients (23.80%) in the double tourniquet group required blood transfusion, compared with 26 (65.00%) in the non-tourniquet group (P= 0.0003). Surgical time did not show a statistical difference between groups. The use of a uterine segment tourniquet in obstetric hysterectomy may improve surgical outcomes in patients with placenta accreta spectrum with no difference in surgical time and urinary tract lesions.

Deep Learning on Medical Imaging in Identifying Kidney Stones: Review Paper

Medical imaging is currently using artificial intelligence-based technologies to aid evaluate diagnostic information images, particularly in enforcing kidney stones. Artificial intelligence technology continues to develop, many studies show that deep learning is more widely used compared to traditional machine learning, so an Artificial intelligence system is needed to assist the accuracy of health diagnoses, thus helping in the field of radiology health. The aim of the research is to use artificial intelligence with deep learning models to help detect abnormalities in the kidneys. This research method is a literature review of Scopus data related to deep learning in medical imaging in detecting kidney stones. The results of using Artificial Intelligence in medical imaging can be used in diagnosing diseases including detecting Covid-19, musculoskeletal, calcium scores on Cardiac CT, liver tumors, urinary tract lesions, examination of the abdomen and kidney stones. Utilization of Artificial Intelligence in detecting kidney stones can be done with various classification models including XResNet-50, ExDark19, CystoNet, CNN, ANN. Using the right model and having a high accuracy value can help radiologists to accurately detect kidney stones.

Инфильтративный эндометриоз с поражением мочеточника – клинический опыт взаимодействия гинеколога и уролога в диагностике, оперативном лечении и наблюдении пациентки

The article is focused on the problem of diagnosis and surgical treatment of infiltrative forms of endometriosis with lesions of both internal genitalia and urinary tract. A clinical observation of a young woman who underwent a robot-assisted operation on the internal genitals and organs of the urinary system is given. The article emphasizes the need for complete clinical examination in women with suspected endometriosis. The young age of patients, even the absence of bright clinic signs or absence of a long anamnesis of the disease should not exclude the possibility of severe case of endometriosis and the possibility of a combined lesions of pelvic organs. If infiltrative endometriosis is detected, the patients treatment should be carried out in a specialized hospital using modern surgical technologies.

Nephrogenic Adenoma Intermixed With Urothelial Carcinoma.

Nephrogenic adenoma (NA) is a common urinary tract lesion typically associated with urothelial disruption, leading to implantation of shed renal tubular cells. NA may demonstrate a spectrum of architectural and cytologic features mimicking urothelial carcinoma (UC), adenocarcinoma (including clear cell adenocarcinoma and prostatic adenocarcinoma), and invasion. However, admixed UC and NA has not been described. To describe cases where the NA was intimately intermixed with UC, potentially mimicking variant differentiation or invasion. In 3 health care systems we identified specimens of NA and UC intimately intermixed with each other where they could mimic a spectrum of one lesion. We assessed patterns of NA and clinical implications of misdiagnosing NA as glandular differentiation of UC. There were 4 women and 29 men (median age, 72 years; range, 31-89 years). Twenty-four patients had transurethral resections, 3 had biopsies, and 6 had major resections. Fourteen had noninvasive high-grade papillary UC, 6 had carcinoma in situ, and 11 had invasive high-grade UC, and in 2 patients, NA developed in a papillary urothelial neoplasm with extensive denudation. Three patients had fibromyxoid NA infiltrated by invasive UC. Classical NA (n = 30) had tubulopapillary (n = 18), pure tubular (n = 7), or pure papillary architecture (n = 5). In 1 lesion, NA was present in muscularis propria, and 2 involved adventitia. NA could have been misdiagnosed as invasion in 17 of 22 (77%) noninvasive tumors, or higher stage in 19 of 33 (58%). NA can be intermingled with high-grade UC, expanding the spectrum of entities that must be considered in the differential diagnosis, as it may mimic glandular or tubular differentiation, invasion, and a higher stage of disease. Misinterpretation of NA in such a setting may incorrectly convey a more aggressive biological potential of cancer to clinicians.

JIM Reading List.

JIM Reading List.

Predicting factors of clinically significant urological anomalies after initial urinary tract infection among 2- to 24-month-old children.

To find more effective criteria to identify clinically significant urological anomalies after initial urinary tract infection among children. Children aged 2-24months with an initial urinary tract infection were consecutively recruited in a Japanese hospital from 2013 to 2019. Voiding cystourethrography, 99mTc dimercaptosuccinic acid scan and ultrasound were intended to perform for all cases. Clinically significant urological anomalies were defined as high-grade vesicoureteral reflux, obstructive and abnormal urinary tract lesions, need for surgical intervention, renal hypoplasia and scarring. Using classification and regression tree analysis, we sought the associated factors. We developed new criteria with these factors, retrospectively applied them to the original data, and calculated the sensitivity and specificity. One hundred sixty-seven patients were eligible, and 39 had clinically significant urological anomalies. Classification and regression tree analysis showed that the associated factors were non-E. coli infections, serum creatinine levels and ultrasound abnormalities. When the gold standards were performed on children with non-E. coli infections or serum creatinine levels ≥0.21mg/dl, sensitivity and specificity were 0.82 and 0.68, respectively. The criteria including non-E. coli infections and high-normal or higher serum creatinine levels may efficiently predict clinically significant urological anomalies after initial urinary tract infections.

CT findings and diagnostic performance of upper urinary tract carcinoma in situ.

To evaluate the CT characteristics and detectability of carcinoma in situ (CIS) of the upper urinary tract. Between January 2007 and March 2020, 28 patients (mean age: 73years, 25 male and 3 female) with 29 pure CIS lesions of the upper urinary tract (i.e., without concomitant non-CIS lesion) who underwent nephroureterectomy were identified. The most recent CT scan performed before ureteroscopy, systemic neoadjuvant chemotherapy, or nephroureterectomy was selected for analysis. Twenty-eight patients without upper tract malignancy were selected as a control group. All images were evaluated for presence of upper urinary tract CIS using confidence levels ranging from 1 to 100 by two radiologists. The confidence level of 75 was used as a cutoff threshold for calculating sensitivity and specificity. The median interval between CT scan and nephroureterectomy was 96days. The number of true-positive lesions (per-lesion sensitivity) was 41% (12/29) and 52% (15/29) by readers 1 and 2. The true-positive lesion appeared as wall thickening in 83% (10/12) by reader 1 and 80% (12/15) by reader 2, and as a mass in 17% (2/12) by reader 1 and 20% (3/15) by reader 2. All mass-forming lesions were located in the renal collecting system. The per-patient sensitivity and specificity were 42% and 100% in reader 1, and 54% and 96% in reader 2. The common abnormal finding of pure CIS in the upper urinary tract was wall thickening. Pure CIS could also appear as a mass-forming lesion when it is located in the renal collecting system. • The common abnormal finding of pure CIS in the upper urinary tract is wall thickening. Gradually progressive urothelial wall thickening and/or worsening symptoms should raise the suspicion of CIS. • Pure CIS in the upper urinary tract also appears as a mass-forming lesion when it is located in the renal collecting system. • Hydronephrosis and fat stranding play an auxiliary role in detecting pure CIS in the upper urinary tract.

Role of 18F-FDG-PET/CT in Combination With Neutrophil-Lymphocyte Ratio in the Diagnosis of Upper Urinary Tract Lesion: Can We Accurately Predict Malignant Tumor?

ObjectiveTo explore whether preoperative 18Fluorine-Fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) in combination with neutrophil–lymphocyte ratio (NLR) could accurately predict malignant lesions of upper urinary tract (UUT).Methods and MaterialsThe clinicopathologic data of a total of 252 patients with UUT lesions receiving surgical treatment at our center from January 2012 to November 2019 were retrospectively analyzed. All patients performed routine preoperative hematological examination, urine cytology, computed tomography urography (CTU), and 18F-FDG-PET/CT. Clinicopathologic data between 179 cases with malignancy (Group 1) and 73 cases with benign lesions (Group 2) were compared. Multivariate logistic regression analysis was used to explore the independent predictors of malignant UUT lesions. Receiver operating characteristic (ROC) curve was used to evaluate the predictive ability.ResultsAmong all patients, univariate analysis showed that NLR, hydronephrosis, CTU indicating malignancy, and PET/CT indicating malignancy were significantly associated with malignant UUT lesions; multivariate analysis revealed that NLR, CTU indicating malignancy, and PET/CT indicating malignancy were independent predictors of malignant UUT lesions; the area under ROC curve (AUC) of NLR, CTU, PET/CT, combining CTU and NLR, combining PET/CT and NLR, and combining PET/CT and CTU were 0.735, 0.788, 0.857, 0.863, 0.913, and 0.919, respectively, for postoperative pathological malignancy. Among 68 patients undergoing ureteroscopy biopsy, univariate analysis suggested that NLR, positive urine exfoliation cytology, CTU indicating malignancy, and PET/CT indicating malignancy were significantly associated with malignant UUT lesions; multivariate analysis demonstrated that positive urine cytology, PET/CT indicating malignancy, and NLR were independent predictors of malignant UUT lesions; the AUC of NLR, ureteroscopy biopsy, and combining PET/CT and NLR were 0.768, 0.853, and 0.839, respectively, for postoperative pathological malignancy.ConclusionsCombining preoperative NLR and PET/CT performed well in differentiating benign from malignant UUT lesions, which could not be identified by traditional imaging or urine cytology. Combining preoperative NLR and PET/CT could be used to reduce unnecessary ureteroscopy biopsy, which might result in tumor cell dissemination and risk of associated complications.

The significance of coronavirus infection in the development of reproductive and lower urinary tract lesions

The impact of COVID-19 on the organs of the genitourinary system is of particular interest to the urologist. There is insufficient information about this influence up to date. The studies are actively developing and require long-term data analysis to determine possible long-term complications, persistent changes in physiological parameters and anatomical and histological structures, as well as to establish the possibility of regression of these changes and complications. The results obtained will undoubtedly improve not only the diagnosis, treatment and prevention of coronavirus infection and its complications, but also make it possible to predict certain disease's outcomes and changes in the function of organs and systems. In turn, this will give an understanding of the measures that need to be taken to completely avoid or minimize these complications and changes.This review focuses on the impact of COVID-19 on genitourinary organs, particularly its place in the development of the lower urinary tract and reproductive organs lesions, as well as the role of androgens in the course of SARS-CoV-2.

Первично-множественные синхронные злокачественные новообразования лоханки почки и обоих мочеточников

Introduction. Urothelial carcinoma of the upper urinary tract in Western countries of Erope and USA occurs in 1-2 cases per 100,000 populations. Nephroretrectomy remains the main method of treatment of this pathology, however, the role of organ-sparing surgeries increases with the bilateral localization of the tumor process. Due to the rarity of bilateral upper urinary tract lesions with urothelial cancer and the lack of data evaluating the results of organ-sparing surgeries in such situations, each clinical case is of interest. Materials and methods. The article describes a case of surgical treatment of a patient with non-invasive papillary urothelial carcinomas of both ureters and the pelvis of the right kidney, which were manifested by macrohematuria. Results. The diagnosis was confirmed by computer tomography (CT) and ureteroscopy with tumor biopsy, which revealed a neoplasm of the right kidney pelvis, multiple tumors of the distal part of the right ureter and a solitary neoplasm of the middle part of left ureter. The patient underwent laparoscopic nephrureterectomy on the right with transurethral resection of the bladder wall in the area of the mouth of the right ureter and endoscopic removal of the neoplasm in the middle third of the left ureter using laser energy. At the control examination 1,5 months after the surgical treatment, according to the results of CT, cystoscopy with biopsy of the bladder and ureteroscopy, as well as histological examination of the biopsies, no data for tumor growth were found. At CT 6 months after the surgery, no data for the recurrence of cancer were obtained. Сonclusions. This clinical observation demonstrates the technical feasibility and oncological feasibility of using organ-preserving surgical treatment for bilateral localization of low-grade urothelial carcinoma.

Current prospects of urine cytology in diagnosis and follow-up urinary tract malignancies - the short review

Introduction and purpose: Cytology of urine sediment is a diagnostic tool used to screen for urinary tract lesions in two cases: surveillance of patients with a history of urothelial malignancies and patients with unexplained, new onset haematuria. Since 2015 histopathological laboratories have been able to report urine cytology according to The Paris System (TPS). Current studies suggest usefulness of urinary cytology in follow-up of urinary tract malignancies, especially urinary bladder cancer, which is the 13th most deadly throughout the world being responsible for 200 000 deaths in 2018 among neoplasms.Objective: To review currently available data on PubMed about usefulness urine cytology reporting in follow-up and diagnosis of urinary tract malignancies.A brief description of the state of knowledge: Advantages of urine cytology examination contain non-invasiveness, high specificity, lower cost than cystoscopy and enable immunohistochemistry performance as well. Implementation of The Paris System for reporting urine cytology has created an universally acceptable and globally used report system. Reporting according to TPS significantly reduced the number of cases described as atypical changes.Conclusions: Urinary cytology is used to supplement endoscopic evaluation of the urinary tract in the screening and the surveillance of urothelial carcinoma. The Paris System for reporting urinary cytology has clarified the diagnostic categories of urine sediment examination. Cystoscopy and urine cytology are the standard tools for monitoring urinary tract malignancies.

Association Between Stability and Urologic Lesions in Pelvic Ring Fractures. A Case Series Report

Purpose Pelvic ring fractures represent a subgroup of potentially serious injuries due to the fractures themselves, as well as the associated injuries. In fact, over 4% of cases have concomitant lower urinary tract injuries. The aim of this study was to analyze the relationship between the instability of pelvic ring fractures and the presence of lower urinary tract lesions. Materials and methods A retrospective review of patients with pelvic ring fractures at our center between 2007 and 2015 was performed. Fractures were categorized according to the Tile classification system. Patients with lower urinary tract lesions were selected and categorized according to the lower urinary tract lesion identified (urinary bladder, urethral or combined). Subsequently, a statistical analysis was carried out to assess the association between these variables. Results 614 patients with pelvic ring fracture were included, corresponding to 260 (42.3%) men and 354 (57.7%) women. 25 patients (4.1%) were diagnosed of lower urinary tract injury (17 bladder injuries, 8 urethral injuries and 0 combined injuries). Urethral injuries were more frequent among men (1.9% incidence in men vs 0.8% in women). A lower incidence of lower urinary tract lesions was detected in stable pelvic ring fractures (type A, p 0.02). Overall, type C3 showed the highest incidence of lower urinary tract lesions (22.2% incidence, p = 0.04). Conclusion In our series, a greater incidence of higher urinary tract injuries was observed in patients with unstable pelvic ring fractures (Tile type B and C) with respect to stable fractures (Tile type A). Therefore, a high index of suspicion should be maintained in order to identify high risk patients.