Abstract
Introduction and hypothesis
The objective was to discuss the evaluation and management of stress urinary incontinence (SUI) following traumatic pelvic injury by use of a video case.
Methods
We present a patient with severe SUI following pelvic trauma and our surgical approach to her case. Her injuries included two sacral compression fractures and four un-united bilateral pubic rami fractures, with her right-upper pubic rami impinging on the bladder.
Results
Preoperative assessment included detailed review of her pelvic imaging, multichannel urodynamic testing, cystoscopy, and examination of periurethral and bony pelvis anatomy. We proceeded with a synthetic retropubic mid-urethral sling, which required medial deviation of the trocar passage owing to her distorted anatomy. Rigid cystoscopy provided an inadequate bladder survey following sling placement, thus flexible cystoscopy was used to confirm the absence of bladder perforation. Postoperatively, our patient experienced resolution of SUI.
Conclusions
In patients who sustain pelvic fractures, imaging to evaluate bony trauma and genitourinary tract injury is essential. Urodynamic testing provides clarity of the nature and severity of incontinence symptoms. Rigid and/or flexible cystoscopy should be performed for diagnostic purposes pre-operatively and after operative intervention. Typical anti-incontinence procedures can be offered to these patients, but since bony anatomy can be unreliable, an individualized approach to their specific injury should be utilized.
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Authors and Affiliations
Contributions
K.E. Nixon: managed the patient, developed the video concept, edited and revised the video, wrote and revised the manuscript; C.K. Kisby: developed the video concept, edited and revised the video, edited and revised the manuscript; B.J. Linder: contributed to the video concept, edited and revised the video, edited and revised the manuscript; B. Kim: contributed to the video concept, edited and revised the video, edited and revised the manuscript; J.B. Gebhart: managed the patient, contributed to the video concept, edited and revised the video, edited and revised the manuscript, mentored the lead author.
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Conflicts of interest
The authors declare that they have no conflicts of interest. Financial disclosures are as follows: K.E. Nixon: nothing to disclose; C.K. Kisby: nothing to disclose; B.J. Linder: nothing to disclose; B. Kim: nothing to disclose; J. B. Gebhart: UroCure (Advisory Board), UpToDate (royalties), Elsevier (royalties).
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Nixon, K.E., Kisby, C.K., Linder, B.J. et al. Surgical management of stress urinary incontinence following traumatic pelvic injury. Int Urogynecol J 32, 215–217 (2021). https://doi.org/10.1007/s00192-020-04449-4
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DOI: https://doi.org/10.1007/s00192-020-04449-4