The objective was to discuss the evaluation and management of stress urinary incontinence (SUI) following traumatic pelvic injury by use of a video case.
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.
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.
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.
International urogynecology journal. 2020 Aug 12 [Epub ahead of print]
Kayla E Nixon, Cassandra K Kisby, Brian J Linder, Bohyun Kim, John B Gebhart
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 259 East Erie Street, Suite 2450, Chicago, IL, 60611, USA. ., Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA., Department of Radiology, Mayo Clinic, Rochester, MN, USA.