Diagnostic challenges in blunt pelvic fracture-related lower urinary tract injuries: a 13-year retrospective study

Pelvic fractures from high-energy trauma are associated with lower urinary tract injuries (LUTI) in 10–15% of cases, leading to significant morbidity if not promptly diagnosed. Bladder and urethral injuries can result in infection, urinary obstruction, and long-term complications. However, diagnosing LUTI in hemodynamically unstable patients remains particularly challenging, as advanced imaging studies such as retrograde cystography, computed tomography (CT) cystography, and retrograde urethrography (RUG) are typically deferred until after initial resuscitation and stabilization. This study reviews 13 years of clinical experience with blunt pelvic fracture-related LUTI, focusing on the diagnostic role of CT imaging. We retrospectively analyzed pelvic fracture cases with hematuria at a tertiary center from 2009 to 2021. All patients received abdominal and pelvic CT scans on admission. We recorded demographic data, injury characteristics, Injury Severity Score (ISS), diagnostic methods, and infection rates. Comparisons were made between patients with bladder and urethral injuries. The characteristics of patients with LUTI diagnosed on initial CT and those with delayed diagnosis were summarized descriptively. Of 2,865 patients with pelvic fractures, 127 (4.4%) were diagnosed with LUTI. The median age was 36 years, and 76% were male, with a median ISS of 26. Bladder injuries were present in 54% of LUTI cases, urethral injuries in 40%, and combined injuries in 6%. Diagnosis via CT was significantly higher for bladder injuries (58%) than urethral injuries (20%). Among those diagnosed with CT in the emergency department, 40% patients did not undergo further urological imaging. Thirteen patients (10%) had delayed diagnoses, primarily due to initial focus on life-saving interventions. No significant difference in outcomes was noted between early and delayed diagnoses. CT imaging is valuable for the initial evaluation of pelvic fractures with LUTI- particularly bladder injuries, by aiding early diagnosis and reducing the need for invasive diagnostic studies. Early recognition, especially within the first two weeks, remains essential to optimize patient outcomes.