Urinary incontinence after pelvic trauma: a case report

International Urology and Nephrology 32: 363–365, 2001. © 2001 Kluwer Academic Publishers. Printed in the Netherlands.

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Urinary incontinence after pelvic trauma: A case report Bora Küpeli, Yakup Kordan & Turgut Alkibay Gazi University, School of Medicine, Department of Urology, Ankara, Turkey

Abstract. Stress and Urge urinary incontinence may develop after a pelvic trauma especially after pelvic bone fractures. Incontinence may persist eventhough any type of bladder neck suspension is performed if malunion occurs between fracture ends. In stress and urge urinary incontinence developed after pelvic trauma, patients should also be evaluated for malunion of fractures which may lead to bone spurs and during any type of bladder neck suspension these should also be removed. Key words: Trauma, Urinary in continence, Bladder

Case report A 47 years old female who had a history of left ischial and pubic bone fractures after a traffic accident 13 years ago, presented with the symptoms of urge and stress urinary incontinence started since then. Detailed study of the history revealed that the patient had undergone some operations for the correction of uterine prolapsus and tubo-ovarian abcess, and finally total abdominal hysterectomy had been performed. She was also advised to take Tofranil 2 × 25 mg daily, however her complaints remained. On physical examination Bonney test was found to be positive. Kidney-uretersbladder film and excretory urography showed a bone fragment on the left ischium which attributed to the malunion of ischio-pubic bone fracture sites, seemed to be in conjunction with the bladder (Figures 1–2). No other abnormality related with the urinary symptoms was detected. Cystometry was performed and she was found to have a normal, stable urinary bladder with sufficient capacity. At the cystoscopic examination, pigmented punctuate lesions on bulging bladder mucosa which matches to the underlying bone fragment had been observed (Figure 3) and the biopsy taken from that area revealed only an inflammatory pattern. The patient underwent Marshall Marchetti Krantz type of bladder neck suspension after the excision of the irritating bone spur which was found to press the urinary bladder (Figure 4). There were no post-operative complication and she voided with

Figure 1. Kidney-ureters-bladder film.

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Figure 3. Cystoscopic view of the bladder mucosa. Figure 2. Excretory Urography of the patient.

minimal complaints of stress but no urge incontinence after the removal of the urethral catheter at 6 post operative day.

Discussion The bladder lies deep within the pelvis and is surrounded by pelvic bones. However, this close relation may affect the bladder adversely after pelvic trauma and several types of bladder injuries may accompany the pelvic fractures. The major injury is the bladder rupture and 72% of patients with trauma of the bladder is associated with fractures [1]. On the other hand, the compression of bone fragments resulting from the malalignmet of fracture ends may disturb the bladder and this can lead to lower urinary tract symptoms including stress and/or urge incontinence. Our patient revealed both types of incontinence, although she had normal cystometry and excretory urography other than a forementioned malunion. There is only a few papers presenting this

Figure 4. Plain x-ray of the pelvis after surgery.

consideration [2, 3] and all are interested in and emphasize to urodynamic findings of the situation. Our case suggests that besides the preoperative considerations including the type of incontinence, degree of vaginal prolapse and urodynamic findings, the presence of other anatomical abnormalities, especially in patients who has a history of pelvic trauma, should

365 be evaluated. If such an abnormality is diagnosed, it should be corrected surgically with or without some kind of bladder neck suspension.

3. Huittinen VM, Slätis P. Fractures of the pelvis. Trauma Mechanism, types of injury and principles of treatment. Acta Chirrurg Scand 1972; 138: 563.

References

Address for correspondence: Bora Küpeli, Beyazgül Sitesi A-1/21, 06530 Ümitköy/Ankara, Turkey Phone: +90 5326164184; Fax: +90 3122129021

1. 2.

Brosman SA, Paul JG. Trauma of the bladder. Surg Gynecol Obstet 1976; 143: 605. Festge VOA, Tischer N, Festge B. Stressinkontinenz nach beckenfractur. Zbl Chirrugie 1984; 109: 254.