Incidence and immediate management of genitourinary injuries in pelvic and acetabular trauma: a 10‐year retrospective study

Objective To report the incidence of genitourinary ( GU ) injuries in pelvic and acetabular (P + A) fractures, to investigate associations between P + A fractures and GU injury patterns, and, as a secondary objective, to evaluate prospectively P + A fracture referrals with regard to adherence to the British Orthopaedic Association Standards for Trauma ( BOAST ) guidelines over a 12‐month period. Methods A retrospective review of GU injuries associated with P + A fractures was performed for the period January 2006 to December 2016 in a national pelvic trauma centre in Ireland. Patient demographics, mechanism of injury and details of injuries were recorded. In addition, P + A fracture referrals were prospectively monitored in 2016 and reviewed for adherence to guidelines. Results The incidence of urological trauma in P + A fractures was 2.4% ( n = 28/1 141). The median (range) patient age was 45 (19–85) years and the male to female ratio was 2.1:1. Urethral injuries occurred most frequently ( n = 12, 43%), followed by bladder ( n = 9, 32%), combined bladder and urethral ( n = 3, 11%) and kidney ( n = 4, 14%). Bladder and urethral injuries were associated with high‐energy pelvic trauma. Renal injuries were associated with acetabular fractures in isolation and in combination with pelvic trauma ( P = 0.01). In 2016, there were 175 P + A fracture referrals and 19 patients had suspected urotrauma (visible haematuria, n = 5; non‐visible haematuria, n = 2; trauma imaging, n = 11); 9 of these 19 patients had no urological investigations performed. Conclusion In P + A trauma cases GU injuries may be underreported because of inadequate evaluation and diagnostic investigations in these patients. We advocate robust, uniform and guideline‐based evaluation of GU injuries in P + A trauma to avoid the significant long‐term morbidities that are associated with misdiagnosis.