Lower urinary tract trauma is a significant contributor to trauma induced morbidity and mortality by posing a significant public health challenge once it happens. It rarely occurs in isolation and is always associated with injuries to other vital organs. We prospectively recruited participants to describe etiology, patterns and short-term outcomes of lower urinary tract trauma in males admitted at MRRH.
In this study, 38 participants were enrolled. The median age was 25 years, this is similar to studies done in Kenya by Oluoch et al., in which their median age was 28 years(7). This is explained by similar environmental and participant characteristics in which both countries are still developing. Most of our population, is characterized by the youth who usually get involved in aggressive sports, motorcycle transport business without obeying traffic rules, and other risky behaviors for example abuse of drugs which has exacerbated crime rate. Similar studies were also observed by CK Orunasi et., in Nigeria(8).
Injury to the lower urinary tract organs occur as a result of blunt, penetrating or iatrogenic trauma. In this study, most of lower urinary tract injuries happened as a result of MVC (n = 26, 52%). Similar studies were reported by Oluoch et., at Kenyatta National Hospital and Nigeria by Ahmed et al., where motor vehicle accidents were the commonest cause accounting for 47.5% and 68% respectively (7) & (9). This could be explained by similar environmental characteristics where majority of the population in sub-Saharan Africa get involved in the commercial motorcycle transport business in which most of the traffic regulations are not observed. Iatrogenic injuries due to circumcision 20.5% (n = 8) was observed to be the commonest cause of urethra injuries urethra injuries in our setting, similar studies were also reported in Nigeria by AN Osuigwe et al(5). This could be explained by the fact that, majority of our children are circumcised at lower health facilities by low health carders with little experience in handling children with under developed genital organs hence predisposing to them to penile amputation. Similar studies were observed by Barry Mi et al., in Guinea(10).
Lower urinary tract trauma includes injuries to the urinary bladder and the urethra. In this study, urethra was the most injured organ (n = 35, 70%). This is similar to the studies done in Kenya in which urethral injury accounted for 51.9%(7). This could be explained by similar etiology in MVC due to motorcycle transport system was the commonest cause.
In this study, extraperitoneal bladder contusion with hematoma was the commonest injury pattern at (9, 60%). This is in agreement with studies done in USA by Phillips et al., which showed that extra-peritoneal bladder injuries were the most common (63%) compared to intra-peritoneal bladder injuries (11). This could have been explained by similar etiologies of bladder injuries in which MVC was the commonest cause.
In our study complete tear of either anterior or posterior part of the urethra, was the commonest injury pattern accounting for (22, 62.9%). This was similar to the studies done in USA by Anish B. Patel et al., in which 65% of urethra injuries were complete tear. This is could be explained by similar etiology of injuries in which most of urethra injuries were due to blunt trauma as a result of motor vehicle accidents (12).
Following treatment of lower urinary tract trauma, majority of participants stayed in the hospital more than 1 week (25, 65.8) and this could be explained by associated injuries and high complication rate in our participants. Similar studies were observed in USA where their average length of hospital stay were 9 days due to concomitant associated injuries (Abel, 2012). In this study, mortality was 5.3% (n = 2), all of them had intra-peritoneal bladder ruptures and also had associated severe injuries which could have explained death in our setting. This is different from studies done in USA, where mortality was at 16%(13). This could be explained by differences in etiology where most of their injuries were due to penetrating injuries as a result of gunshot. Overall complication was (22, 57.9%). Similar studies were documented at a teaching hospital of Treichville, Abidjan, Cote d’lvoire at 34%(14).
Bleeding per urethra was the commonest complication following treatment (14, 36.8%). This could be explained by robust blood supply of the urethra and other pelvic organ system which is worsened by associated unstable pelvic fractures despite of urinary diversion. Different studies were documented in USA, where the complication rate was lower at 15%(15)and 32%(16). This could be explained by a better health care system in USA where most of the LUTT is diagnosed early and endoscopic procedures are done such as urethral realignment