Diagnosis and management of pelvic fracture urethral injuries in men: a literature review
DOI:
https://doi.org/10.11603/2414-4533.2026.2.16437Keywords:
pelvic fracture urethral injury, PFUI, pelvic fracture urethral distraction defect, PFUD, retrograde urethrography, primary urethral realignment, urethral stricture, anastomotic urethroplasty, reconstructive urology, combat traumaAbstract
The aim of the work: to analyze scientific publications on the diagnosis and treatment of urethral distraction injuries in pelvic fractures, as well as to summarize current issues on this problem.
Materials and Methods. The analysis included randomized controlled trials, prospective and retrospective cohort studies, systematic reviews, and meta-analyses. Pelvic fractures in men are the result of high-energy trauma and pose a particular clinical problem in wartime. One of the most severe complications is pelvic fracture urethral injury (PFUI), which in the acute phase may lead to urinary outflow obstruction, urinary extravasation, and infectious or septic complications, while in the long term it is associated with urethral stricture, erectile dysfunction, and urinary incontinence. As PFUI predominantly affects young patients, its consequences have a substantial impact on work capacity and overall quality of life. This review summarizes current data on the epidemiology, pathophysiology, and mechanisms of PFUI, as well as the anatomical prerequisites for the development of distraction defects. The relationship between pelvic fracture patterns, shear forces, and the risk of urethral injury is analyzed, and contemporary concepts regarding the typical location of rupture in adults and the differences observed in children are presented. The clinical manifestations of PFUI are described, with emphasis on the fact that the absence of urethrorrhagia does not exclude urethral injury.
Results. Retrograde urethrography remains the diagnostic standard for PFUI in the acute setting, allowing accurate assessment of the level and extent of injury. In selected cases during delayed management, magnetic resonance imaging may be useful for detailed anatomical evaluation and for planning reconstructive surgery. The primary goal of acute management is rapid and safe urinary diversion. Suprapubic cystostomy is considered the baseline approach, whereas primary urethral realignment may be applied selectively in hemodynamically stable patients with appropriate expertise. Regardless of the initial strategy, a significant proportion of patients develop urethral stricture within the first year, necessitating prolonged follow-up. In the delayed setting, the gold standard for the treatment of urethral distraction defects is delayed anastomotic perineal urethroplasty performed after completion of tissue healing.
Conclusions. This review highlights the importance of early referral to specialized reconstructive urology centers and avoidance of repeated low-efficacy endoscopic procedures, as the first reconstructive operation largely determines long-term functional outcomes.
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