Spine and Spinal Cord Injuries

Pelvic fracture secondary to blunt trauma is associated with significant multiorgan system injuries, including to the bladder and urethra. There should be a high suspicion of urologic injury in patients with disruption of the pelvic ring. Though presentation can be variable, gross hematuria and blood at the urethral meatus in a patient with pelvic trauma are the most reliable indicators of bladder and urethral injury, respectively. Early urologic consultation is recommended in such patients. Diagnosis can easily be made with cystogram and retrograde urethrogram. Management focuses on prompt urinary drainage and minimizing acute and long-term morbidity. Some complex or high-risk injuries require primary repair, but the majority can be managed acutely with catheter drainage alone. Long-term follow-up with urology is crucial to monitor for urethral stricture disease, erectile dysfunction, and urinary incontinence.