Profile and treatment outcomes of lower urinary tract injuries in patients with pelvic trauma at Muhimbili National Hospital and Muhimbili Orthopaedic Institute

Abstract

ABSTRACT Background Lower urinary tract injuries are common in pelvic trauma cases and they are highly associated with high morbidity and even mortality. There is no data regarding lower urinary tract injuries associated with pelvic trauma in Tanzania. This study described experiences in the management and outcome of lower urinary tract injuries following pelvic trauma in our local setting. In some occasions symptoms of LUT injuries are overlooked in patients with concomitant pelvic trauma which leads to severe complications. Various complications are seen, associated with lower urinary tract injuries in patients with pelvic trauma in our setting. Different treatment modalities have been used with different outcomes Patients tend to present late, required intervention is often delayed, which contribute to adverse outcome.

Objective The objective of this study was to determine the proportion of lower urinary tract injuries among pelvic trauma patients and their treatment outcomes at MNH and MOI between April 2017 May 2018.

Method This was a prospective hospital based study conducted for a period of 14 months at MNH and MOI on patients having lower urinary tract injuries among patients with pelvic trauma. Data collected direct from patients, through history taking and physical examination, as well as from intraoperative findings were used to form data set. Also notes from patients’ files and computer database on out-patient follow up visits were used to record patient’s particulars, clinical presentation, type of treatment received, and their complications. Data entry and analysis were done by SPSS computer program.

Results In this study 724 patients with pelvic trauma were identified within the study period, out of those 54 patients with LUT injuries were studied, it has been seen that among the pelvic trauma patients with LUT injuries the majority were males 40 (74.1%) while females were 14 (25.9%). Out of 40 males 29 (72.5%) had bladder injury while 7 (17.5%)patients had urethral injury and 4 (10.0%) had combined bladder and urethral injury. Out of 14 female subjects, 10 (71.4%) had bladder injury, 2(14.3%) had urethral injury and 2 (14.3%) had combined bladder and urethral injury. The proportion of bladder and urethral injuries for men was4.0% and 0.97% respectively, and in women was 1.4% and 0.28%, respectively. And proportions of combined injuries in men were0.55% and in women was 0.28%. Following LUT injuries in the study hematuria was the commonest clinical feature of LUT injury in the study sample which accounts for 98.1%, followed by abdominal pain, 87.0%, painful micturition,72.3%, where difficulty in passing urine occurred in 46.3%, and blood per urethral meatus in 29.6%. Twenty-four (54.5%) patients of bladder injuries were managed conservatively, while20 (45.5%) cases were managed surgically. Twelve (80.0%) cases of urethral injury were treated conservatively with urethral catheter or SPC catheter while only 3 (20.0%) cases were treated surgically. Conclusion Due to the above findings having pelvic trauma is a predisposing factor to lower urinary tract injuries including bladder and urethral injuries or both, of which bladder injuries are the commonest. Males are more commonly affected than females. Gross hematuria is the commonest clinical presenting symptom of LUT injuries in pelvic trauma patients which gives an alarming sign of LUT injury in a setting of pelvic trauma so that further evaluation of lower urinary tract is to be done, and appropriate measures will be taken. Other symptoms include abdominal pain, painful micturition and blood per urethra.