Predictive Factors of Lower Urinary Tract Injuries and Spontaneous Voiding Failure After Pelvic Fractures

Abstract

Background/Aim: This study aimed to describe the voiding patterns of patients after surgical treatment of pelvic fractures and determine the predictive factors of lower urinary tract injuries (LUTIs) and spontaneous voiding failure among patients with surgically treated pelvic fractures at a tertiary trauma center in Japan. Patients and Methods: We retrospectively assessed patients with surgically treated pelvic fractures in our tertiary trauma center during May 2009-April 2021. We excluded patients who died during hospitalization and who had indwelling catheter prior to the injury. Patients' LUTIs and spontaneous voiding failure at discharge were recorded. Multivariate analysis was performed to assess the predictive factors of LUTIs and spontaneous voiding failure at discharge. Results: In total, 334 eligible patients were identified. Among them, 301 patients (90%) voided spontaneously with or without diapers at discharge. Thirty-three patients required some form of catheterization for bladder drainage. LUTIs were found to be associated with chronological age [odds ratio (OR)=0.96; 95% confidence interval (CI)=0.92-0.99; p=0.024] and pelvic ring fracture (OR=12.0; 95%CI=1.39-255.2; p=0.024). Spontaneous voiding failure was associated with intensive care unit admission (OR=7.17; 95%CI=1. 49-34.4; p=0.004). Conclusion: Overall, 10% of patients with surgically treated pelvic fractures were not able to void spontaneously at discharge. Spontaneous voiding failure after pelvic fractures was related to injury severity.Overall, 2%-8% of all fractures are pelvic fractures, and motor vehicle accidents, falls, and industrial injuries are the most common causes of these fractures (1, 2). Pelvic fractures that require surgical stabilization are usually caused by high-energy trauma and are related to significant morbidity, mortality, and high cost (2, 3). Approximately 2%-25% of patients with pelvic fractures present with associated lower urinary tract injuries (LUTIs), such as bladder and urethral injuries, and these injuries cause longterm complications and a decrease in quality of life (1, 4-6). Erectile dysfunction, incontinence, and urethral strictures have been reported as long-term complications of LUTIs associated with pelvic fractures (7, 8). Additionally, patients with pelvic fractures have been reported to have urinary dysfunction in the absence of LUTIs. Notably, there are several studies investigating the incidence and epidemiology of urinary dysfunction in patients with pelvic fractures (9-12). However, these studies used various questionnaires, and detailed information regarding voiding patterns in patients with pelvic fractures has not been reported.The present study aimed to describe the voiding patterns of patients after surgical treatment of pelvic fractures and determine the predictive factors of LUTIs and spontaneous voiding failure in patients with surgically treated pelvic fractures at a tertiary trauma center in Japan.