INTRODUCTION Patients with pelvic fractures are at risk for concurrent urinary tract injuries such as bladder, ureter or urethral lesions.Treatment guidelines differ between institutions and especially bladder injuries are considered to negatively affect outcome.We hypothesized that concurrent bladder injuries in trauma patients with pelvic injury are associated with impaired outcome METHODS
A single center retrospective study on adult patients with pelvic trauma and UTIs was performed.2 groups were compared:Gr. BLAD, included patients with bladder injuries, whereas individuals with ureter or urethra injuries were selected for Gr. URET.Outcome parameters included: length of hospital (HLOS) and intensive care (ICU-LOS) stay, complication-rates incl. infections and mortality RESULTS A total of 43 (12f/31m) patients with a mean age of 43 (std.:20) years were included.A mean ISS of 37 (std.:10) was calculated. Gr. BLAD included 33 individuals.10 patients were selected for Gr.URET.No differences in baseline characteristics were found.The BLAD-group had significantly more cases with infectious complications than the URET-group (resp. 60.1 vs 20.0%, P=0.03).Most patients had gram-negative infections (N=15), 8 patients had gram-positive bacterial infections.Candida-infections were diagnosed in 5 individuals.A total of 15 patients developed sepsis.No differences in ICU and hospital-stay were found.The overall mortality rate was 16.3% and did also not differ between conditions CONCLUSION
The occurrence of concurrent traumatic injuries of the urinary tract in patients with pelvic trauma is associated with high rates of infectious complications and sepsis.Infection rates are higher in associated bladder injuries than ureter or urethra lesions.Gram-negative bacteria are most frequently involved, which is of increasing clinical importance due to their high resistance to antibiotics.Co-treatment of urinary tract injuries in pelvic trauma should be a focus of future research

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