Management of complex pelvic fracture urethral injury following high-energy trauma in female patients: a case series.

INTRODUCTION AND

OBJECTIVES

Female pelvic fracture urethral injury (PFUI) with vaginal trauma following high-energy collision trauma is rare and challenging to manage, particularly in delayed presentations complicated by urinary and vaginal sequelae. This case series aims to describe the clinical presentation, management strategies, and outcomes of patients with complex PFUI associated with vaginal injury.

MATERIALS AND

METHODS

We retrospectively reviewed the medical records of three female patients who underwent surgical treatment for pelvic fracture urethral injury (PFUI) at our hospital. Imaging findings, operative details, endoscopic findings, and clinical outcomes were collected and analyzed.

CASE PRESENTATION: Three female patients were referred to our tertiary center with complex pelvic fracture urethral injury (PFUI) associated with vaginal trauma following high-energy collision trauma. Case 1 was a 6-year-old girl who had undergone suprapubic diversion for 11 months and presented with complete urethral obliteration, urethrovaginal fistula, and vesicolithiasis. Case 2 was a 9-year-old girl with a 9-month history of suprapubic diversion due to distal urethral obliteration/stenosis and extensive vaginal synechiae. Case 3 was a 19-year-old woman with long-term suprapubic diversion complicated by posterior urethral stenosis, complete vaginal synechiae, urethrovaginal fistula, and colpolithiasis. Management was individualized: Case 1 underwent endoscopic realignment; Case 2 underwent vaginal synechiolysis and pullthrough mucosal vaginoplasty; and Case 3 underwent vaginal synechiolysis with neovaginal reconstruction using a placental graft. All patients achieved spontaneous voiding with urinary continence and maintained vaginal patency during follow-up.

CONCLUSIONS

Management of female PFUI with associated vaginal injury should be individualized based on the anatomical defect and functional objectives. Staged reconstruction and longterm follow-up may be required to optimize urinary continence and vaginal function.