Personal watercraft-related perineal trauma: acute management and assessment of digestive, urological and sexual functional sequelae—a French multicenter retrospective case series

Abstract Background The use of personal watercraft has increased substantially over the past decades. Although uncommon, personal watercraft accidents can result in severe perineal injuries. The mechanisms of injury, management strategies, and long-term functional outcomes remain poorly documented. Methods We conducted a nationwide retrospective study to identify cases of perineal injury following personal watercraft accidents in France between January 2017 and December 2023. We describe the diagnostic and therapeutic management of this case series and report the associated functional outcomes. Results During the study period, 15 cases were identified across six French tertiary and non-tertiary centres. All patients were female passengers seated at the rear of the watercraft, with a median age of 21 years [18–24], and none were wearing protective suits. All patients underwent surgical exploration, either through a perineal approach alone (n = 5) or a combined abdominal and perineal approach (n = 10). Perineal trauma most frequently involved a single-organ injury (n = 8, 53%). One vaginal perforation and six low rectal perforations (40%) were reported. Ostomy formation was required in nine patients (60%), and severe postoperative morbidity occurred in 60% of cases. At functional follow-up, two patients remained diverted and two experienced severe faecal incontinence (Wexner score > 10). Dyspareunia was reported by four patients (31%), while three (23%) required intermittent self-catheterisation. Overall, 23% of patients reported poor health status, and 31% described persistent psychological and/or physical limitations related to the injury. Conclusion Although rare, personal watercraft-related perineal injuries are associated with severe and sometimes irreversible sequelae, leading to impaired quality of life. Prompt and systematic diagnostic assessment and management are therefore essential to minimise long-term functional impairment. Trial registration The study was registered on 16th April 2024 on clinicaltrials.gov (NCT06368284).