Quantifying Urinary and Sexual Dysfunction After Pelvic Fracture

Lefaivre, Kelly A.; Roffey, Darren M.; Guy, Pierre; O’Brien, Peter J.; Broekhuyse, Henry M.

doi:10.1097/bot.0000000000002247

Cited by 6 publications

(6 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ICU admission was found as a predictive factor of spontaneous voiding failure at discharge, and chronological age and pelvic ring fractures were found as predictive factors of LUTIs. Several investigators have evaluated the incidence and clinical characteristics of urinary dysfunction associated with pelvic fractures (9)(10)(11)(12). However, the studies by these investigators were based on various questionnaires, and the definition of urinary dysfunction varied from study to study.…”

Section: Discussionmentioning

confidence: 99%

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

Kaneko¹,

Yanagida²,

Matsui³

et al. 2023

In Vivo

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Kaneko¹,

Yanagida²,

Matsui³

et al. 2023

In Vivo

View full text Add to dashboard Cite

show abstract

“…The group found that men had significant worsening and persistent urinary symptoms 5 years after injury. Furthermore, in men, neurologic dysfunction was found to be predictive of worse ICIQ scores (82). In patients with urinary incontinence and history of pelvic fracture, bladder function must be assessed.…”

Section: Pelvic Fracture Related Bladder Dysfunctionmentioning

confidence: 99%

Management of male stress urinary incontinence in high-risk patients: a narrative review

Lin¹,

Skokan²,

Wessells³

et al. 2023

Transl Androl Urol

View full text Add to dashboard Cite

Background and Objectives: The artificial urinary sphincter (AUS) remains the gold standard for treatment of stress urinary incontinence (SUI). However, highly complex patients such as those with bulbar urethral compromise, bladder pathology, and lower urinary complications pose a particular challenge for the surgeon. In this article, we will address critical risk factors and synthesize existent data across relevant disease states to support surgeons in successful management of SUI in high-risk patients.Methods: A comprehensive review of current literature was performed utilizing the search term "artificial urinary sphincter" in conjunction with any of the following additional terms: "radiation", "urethral stricture", "posterior urethral stenosis", "vesicourethral anastomotic stenosis", "bladder neck contracture", "pelvic fracture urethral injury", "penile revascularization", "inflatable penile prosthesis", and "erosion". Guidance is provided based upon expert opinion where existing literature was sparse or nonexistent.Key Content and Findings: Several known patient risk factors are associated with AUS failure and can ultimately lead to device explantation. Each risk factor requires careful consideration and investigation, or intervention as appropriate, prior to device placement. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients. Several surgical strategies to decrease device complications can be considered: optimization of testosterone, avoidance of 3.5 cm AUS cuff, transcorporal AUS cuff placement, relocation of AUS cuff site, use of lower pressure-regulating balloon, penile revascularization, and intermittent nocturnal deactivation.Conclusions: A number of patient risk factors are associated with AUS failure and can ultimately lead to device explantation. We present an algorithm for management of high-risk patients. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients.

show abstract

“…[15][16][17] Recent work describing the trajectory of recovery in other major musculoskeletal injuries has highlighted the significant clinical change that occurs beyond a year after these injuries. [18][19][20][21][22] Such an evaluation of the trajectory of recovery in acetabulum fractures has not been reported in the literature to date.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the trajectory of recovery following surgically treated acetabular fractures

Tucker,

Roffey,

Guy

et al. 2024

Bone Joint J

Self Cite

View full text Add to dashboard Cite

AimsAcetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years.MethodsEligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient-reported outcome measures (PROMs), including the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS), were recorded at baseline pre-injury recall and six months, one year, two years, and five years postoperatively. Comparative analyses were performed for elementary and associated fracture patterns. The proportion of patients achieving minimal clinically important difference (MCID) was determined. The rate of, and time to, conversion to total hip arthroplasty (THA) was also established.ResultsWe recruited 251 patients (253 fractures), with a 4:1 male to female ratio and mean age of 46.1 years (SD 16.4). Associated fracture patterns accounted for 56.5% of fractures (n = 143). Trajectory analysis showed all timepoints had significant disability versus baseline, including final follow-up (p < 0.001). Elementary fractures had higher SF-36 PCS at six months (p = 0.023) and one year (p = 0.007) compared to associated fractures, but not at two years (p = 0.135) or five years (p = 0.631). The MCID in SF-36 PCS was observed in 37.3% of patients (69/185) between six months and one year, 26.9% of patients (39/145) between one and two years, and 23.3% of patients (20/86) between two and five years, highlighting the long recovery potential of these injuries. A significant proportion of patients failed to attain the MCID after five years (38.1%; 40/105). Conversion to THA occurred in 13.1% of patients (11/110 elementary and 22/143 associated fractures). Approximately two-thirds of THAs (21/33 patients; 63.6%) were performed within two years of index surgery.ConclusionAcetabular fractures significantly impact physical function. Recovery trajectory is often elongated beyond one year, with two-thirds of our patients displaying persistent clinically relevant long-term disability.Cite this article: Bone Joint J 2024;106-B(1):69–76.

show abstract

Quantifying Urinary and Sexual Dysfunction After Pelvic Fracture

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 6 publications

References 52 publications

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

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

Management of male stress urinary incontinence in high-risk patients: a narrative review

Evaluation of the trajectory of recovery following surgically treated acetabular fractures

Contact Info

Product

Resources

About