Urological implications of pelvic trauma

Pelvic trauma is a complex condition with lesions that might extend to the peritoneal organs, spinal cord or adjacent bones. Causes of trauma in this region are diverse, with various degrees of incidence corresponding to different geographical areas – traffic accidents tend to be more common in Western countries, while military conflicts are responsible for more traumas in war regions. Other possible causes include domestic or work-related incidents or accidents. While trauma of pelvis is a generic term, the impact on the pelvic organs, namely the urogenital system, is a serious condition, with potential lethal risk. The authors of the paper present the results of a comprehensive research activity, based on reviewing English language papers indexed on Medline. One interesting aspect is that men have a twofold risk of pelvic organ lesions compared to females, and that age is not a risk factor by itself. The lesion of the boney pelvis is also not a prognostic factor for the evolution of the patient, although the lesion of one or more urogenital organs virtually doubles the death risk. It seems reasonable to believe that the extent of the lesion of the skeletal pelvis determines the extent of the visceral lesions, and this review underlines the mainstay role of the symphyseal joint as the most important risk factor for severe organ trauma. The incidence of urinary organ lesions after pelvic trauma ranges from 25 to 30%, with the bladder and urethra accounting for most cases. The diagnosis of the lesion is based on either imaging or surgical exploration. Urethral damage is proven to be rare after pelvic trauma, with a higher incidence in men compared to women. The localization and extent of the lesion on the pelvic bones is correlated with the risk of urethral lesions, and this has to be kept in mind when performing the assessment of the patient. One important conclusion of the authors is that clinical evaluation could be enough to rule out urethral le-sions but, in case of any suspicion, a retrograde ure-thrography must be carried out before any other maneuver , such as catheterization. CT and MRI have limited use for evaluating urethral lesions. The available data suggests that CT scanning is the most valuable tool for assessing the extent of the lesions. Anyhow, we need to keep in mind that in many countries or hospitals, the CT scan might not be available anytime or even …