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7
UDC 616.6:616.718.19-001
UROLOGICAL CONSEQUENCES OF PELVIC INJURIES
1 Altai State Medical University, Barnaul
2 Regional Clinical Hospital of Emergency Medical Care, Barnaul A.I. Neimark1, A.N. Voitenko2, A.V. Bondarenko12, I.V. Kruglykhin12
The aim of the study is to identify the frequency and nature of disorders of the urogenital system in patients with pelvic injury.
Research methods. The study was based on the results of the examination and treatment of 254 patients with unstable pelvic ring injuries aged from 10 to 79 years who underwent surgical treatment in the department of severe concomitant injury from 2000 to 2016. All patients were included in the study by a continuous method. Results. The severity of erectile dysfunction was slightly higher in men with pelvic ring damage (22.2%). There was a decrease in physical activity in men with pelvic ring injuries. Key words: erectile dysfunction, pelvic ring injury.
Pelvic injuries perform a significant effect on urinary function, also causing sexual disorders. Most often, in 22.7-24.8% of cases [1], they are represented by an overactive bladder, which is characterized by urinary urgency, frequent urination, nocturia with or without imperative urinary incontinence [2]. Disorders in men are manifested in the form of erectile dysfunction (ED) and pain [3, 4, 5, 6, 7]. According to researchers, sexual dysfunction occurs in 20-80% of men after pelvic injuries [3, 8]. The rupture of the pubic symphysis is often associated with temporary ED, and in 19% of those affected, it becomes permanent. Similar disorders are observed by damage to the posterior complex of the pelvis [8, 9].
The presence of pelvic fractures provokes exacerbation of existing problems and conflicts, causing serious social maladjustment of patients with further development of depression [10, 11], which develop in 14.2-42% of cases [10, 12, 13].
When treating pelvic injuries, consideration should be given to the possibility of developing sexual disorders in patients. It is necessary to organize the right tactics to help patients, improve their quality of life and accelerate their social adaptation.
Objective: to identify the frequency and nature of disorders of the genitourinary system in patients with pelvic trauma.
Materials and methods
The work was based on the results of the examination and treatment of 254 patients with unstable pelvic ring injuries aged 10 to 79 years who underwent surgical treatment in the department of severe concomitant injury of the FSBHI Regional Clinical Hospital of Emergency Medical Care of Barnaul from 2000 to 2016. All patients were included in the study by a continuous method.
Pelvic injuries in patients were the result of high-energy impact. The consequence was the presence of several more severe injuries: fractures of the
skeleton bones of other localizations, traumatic brain injury, ruptures of internal organs, etc.
The study included patients with partially stable and unstable pelvic ring injuries according to the AO/ASIF classification [14]. All patients in the period from 1 day to 3 weeks were exposed to osteosynthesis of the pelvic ring. During osteosynthesis, external fixation devices were used, as well as internal fixation by plates and screws.
General clinical, radiological, ultrasound, clinical expert and statistical methods were used to diagnose, assess the patient's general condition and monitor the effectiveness of therapeutic measures. In 90 (35.4%) men, the long-term results and the function of the urogenital system, the quality of life from 1 year to 10 years after injury, were studied.
To study violations in the sexual sphere, there was used the scale of the severity of ED (international index of ED - ICEF - 5) [15]. A urinary diary was used to characterize urinary disorders. The health-related quality of life was assessed using the MOSSF-36 questionnaire.
Results and discussion
Long-term results of treatment were evaluated in terms of 3 to 12 years after discharge from the hospital. With the help of postcards, patients undergoing treatment were invited for a follow-up examination in terms of 3 years after the injury. 90 patients were examined, which accounted for 35.4% of the primary cohort of males.
41 (45.6%) of the examined men had urinary disorders. Tables 1 and 2 show the disorders according to the urination diary.
As follows from Table 2, according to the urination diary, the patients showed a decrease in the average volume of excreted urine, an increase in the number of urinations per day. Along with this, such violations as imperative urges and episodes of imperative urinary incontinence (IUI) were identified.
Table 1
Data of urination diary in patients with impaired urinary function (M±a)
Indicators n=41 Norm
Average volume of one urination (ml) 72,2±34,2 150,0-300,0
Urination number (per day) 13,2±3,21 Under 8
Imperative urge number (per day) 5,3±1,21 No
Number of episodes of imperative urinary incontinence (per day) 4,2±1,32 No
Data of urination diary in Table 2 patients with impaired urinary function (M±a)
Indicators Group 1 (n=34) Norm
Imperative urge 5,3±1,21 No
IUI 4,2±1,32 No
Number of urinations at night 5,7±0,32 No
Feeling of incomplete bladder emptying 1,3±0,11 No
Painful urination 1,2±0,12 No
Sum total 17,7 -
As follows from Table 2, in the examined patients with identified pathology of the urinary system, severe disorders prevailed.
As the analysis of functional urination disorders in the late period showed, they mainly developed in patients with open unstable pelvic ring injuries. These injuries were accompanied by ruptures
As follows from Table 3, the severity of ED was in 21 (22.2%) men with a score of less than 22 points. Normally, more than 22 points are noted.
Mild and moderate erectile dysfunction occurred in patients with partially stable pelvic injuries. Severe abnormalities were found in patients with bilateral damage to the pelvic ring type C and neurological disorders of the sacral and coccyx plexus. Often, erectile dysfunction has been observed in patients with residual displacement of hemipelvis, who underwent a urethral rupture. A severe degree of ED was observed in a patient with damage to the pelvis of type C3.3 with a rupture of the pubic symphysis and a vertical displacement of
of the urinary organs, bilateral pelvic injuries with residual and secondary displacement of the posterior complex. Unresolved displacements in the posterior half-ring of the pelvis were more often observed in patients with ANF.
The degree of ED was evaluated in 90 men and is presented in Table 3
half of the pelvis on the side of complete damage to the posterior semicircle through a fracture of the sacrum with neurological disorders of the sacral plexus. A moderate degree of dysfunction was observed in two patients with ruptures of the urethra and bilateral damage to the posterior half of the pelvis. A mild degree was observed in 1 patient with damage to the urethra and damage to the pelvis type B1. Two patients had damage to the pelvis type B1, three - type C1, with a residual displacement in the posterior half-ring of the pelvis and pain syndrome.
Patients with unsatisfactory results were presented by victims with complete bilateral pelvic
Table 3
The severity of ED in patients in groups
Indicator n=90 P
Norm 70 (77,8%) >0,05
Mild degree of dysfunction 13(14,4%) >0,05
Moderate degree of dysfunction 5 (5,6%) >0,05
Severe degree of dysfunction 2 (2,2%) >0,05
damage, especially with instability of the posterior complex through the rupture of ligaments. A good result was found in patients with unilateral lesions with fractures of the posterior complex of the pelvis.
The quality of life associated with health was assessed using the MOS SF-36 questionnaire, the results are presented in Table 4.
Table 4
Indicators of quality of life (questionnaire "MOS SF-36") in interviewed patients
n=90 P
1 2 4
PhysicalFunctiong (PF) 80±6 <0,001
RolePhysical (RP) 78±4 <0,001
Bodily pain (BP) 80±5 <0,001
GeneralHealth (GH) 78±5 <0,001
Vitality (VT) 72±6 <0,001
SocialFunctioning (SF) 79±4 <0,001
Role-Emotional (RE) 81±3 <0,001
MentalHealth (MH) 76±5 <0,001
Sum total 78±3 <0,001
As follows from Table 4, patients had a relatively reduced physical activity, which limited their daily activities, leading to impaired social communication. In addition, there was noted the presence of a reduced psycho-emotional background due to depressive, anxious experiences. This was determined by the limitations associated with the presence of ANF and the need for manipulation with it, as well as a long rehabilitation period, which affected the psycho-emotional status. By evaluation of pain intensity (BP) and physical function (PF), low scores in patients indicated that pain significantly limited physical activity.
Conclusion
The analysis of complaints and diaries of urination showed that patients had a decrease in the average volume of urine, an increase in the number of urinations per day, imperative urges and IUI episodes (45.6%). The severity of erectile dysfunction was slightly higher in men with pelvic ring injuries (22.2%). There was a decrease in physical activity in men with pelvic ring injuries. This was determined by the limitations associated with the presence of ANF and the need for manipulation with it, as well as a long rehabilitation period, which affected the psycho-emotional status.
References
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Contacts
Corresponding author: Voitenko Aleksei Nikolaevich, Candidate of Medical Sciences, urologist of the Department of severe concomitant trauma of the Regional Clinical Hospital of Emergency Medical Care, Barnaul. 656038, Barnaul, Komsomolsky Prospekt, 73. Tel.: (3852) 245604. Email: alexey_voytenko@mail.ru
Author information
Neimark Aleksandr Izrailevich, Doctor of Medical
Sciences, Professor, Head of the Department of Urology
and Andrology with the courses of specialized surgery,
Altai State Medical University, Barnaul.
656038, Barnaul, Lenina Prospekt, 40.
Tel.: (3852) 404741.
Email: urologagmu@mail.ru
Bondarenko Anatoly Vasilyevich, Doctor of Medical Sciences, Professor, Head of the Department of Urology and Andrology with the courses of specialized surgery of the Altai State Medical University, Head of the Department of severe concomitant trauma of the Regional Clinical Hospital of Emergency Medical Care, Barnaul. 656038, Barnaul, Lenina Prospekt, 40. Tel.: (3852) 404741. Email: urologagmu@mail.ru
Kruglykhin Ivan Vasilyevich, traumatologist of the Department of severe concomitant trauma of the Regional Clinical Hospital of Emergency Medical Care, Barnaul.
656038, Barnaul, Komsomolsky Prospekt, 73.
Tel.: (3852) 245604.
Email: urologagmu@mail.ru
