Clinical and epidemiological features of pelvic fractures presenting to the emergency department in a tertiary health care hospital in south India:A retrospective study

Objective:To determine the clinical and epidemiological features of pelvic fracture patients presenting to the Emergency Department.Methods:This prospective observational study was conducted in a tertiary care center in south India.Causes of injury,types of pelvic fractures,the associated injuries,and outcome at the time of discharge were recorded.Results:A total of 140 patients were included in this study.Most patients were classified as type A(n=62),followed by type B(n=48)and type C(n=30).A total of 112 patients were injured due to road traffic accidents,followed by a fall from a height(n=23)and a fall from a heavy object(n=5).Most subjects had facial injuries(n=99,70.7%),followed by head injuries(n=51,36.4%).Five percent of the patients were expired,12%left against medical advice,and 83%were discharged.Conclusions:The incidence of pelvic fractures presenting to the Emergency Department is relatively high in India.Road traffic accidents are the primary cause of pelvic fractures and associated facial and head injuries.The outcomes demonstrate the need for improved prevention strategies and comprehensive management protocols to reduce mortality.

A Retrospective Analysis of the Patterns and Outcomes of Tile B and Tile C Pelvic Fractures in Cameroon

Background: Pelvic fractures constitute about 2% - 8% of all fractures. This incidence may rise up to 25% in poly-traumatised patients. These fractures have a high mortality rate due to the fact that they occur usually as a result of high energy trauma, and most of the injured are poly-traumatised with concomitant haemodynamic instability. The aim of this study is to describe the patterns of injury and complications of unstable pelvic fractures treated in a level III hospital in Cameroon. Methodology: This was a hospital based retrospective analysis of files of patients admitted and treated for unstable pelvic fractures at the Regional Hospital Limbe within a period of 10 years (from 1st of January 2009 to 31st of December 2018). Results: A total of 139 cases of pelvic fractures were identified, amongst which 77 were unstable;68 were finally analyzed. The ages ranged from 18 to 80 years with a mean of 39 ± 5 years. The age group from 20 - 40 years was most represented (58.88%, n = 40). There were 45 males and 23 females giving a sex-ratio of 2:1. Road traffic injuries accounted for most of the cases (73.53%, n = 50). Forty-five (66.2%) were classified Tile B and 23 (33.82%) were Tile C, and 15 cases were open fractures (22.06%). Associated lesions were recorded in 30 cases, fractures of the lower extremity being the most common (33.33%, n = 10). Most of the cases were definitively treated surgically (80.89%, n = 55). The most common complications were surgical site infections (23.64%, n = 13). Conclusion: Unstable pelvic fractures are relatively common. Young males in the age group 20 - 40 years are the most affected, and the most common cause of injury was road traffic accident. Surgical site infections, pressure ulcers, severe anaemia and thrombo-embolism are common complications.

Management of complex and redo cases of pelvic fracture urethral injuries

Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.

Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures

Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fracture.Navigationguided,percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages,which include less trauma,faster recovery times,and less bleeding.However,due to the complexity of pelvic anatomy,doctors often encounter some problems when using navigation to treat pelvic fractures.This article reviews the indications,contraindications,surgical procedures,and related complications of this procedure for the treatment of sacral fractures,sacroiliac joint injuries,pelvic ring injuries,and acetabular fractures.We also analyze the causes of inaccurate screw placement.Percutaneous screw placement under navigational guidance has the advantages of high accuracy,low incidence of complications and small soft-tissue damage,minimal blood loss,short hospital stays,and quick recovery.There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones.However,computer navigation technology requires extensive training,and attention should be given to avoid complications such as screw misplacement,intestinal injury,and serious blood vessel and nerve injuries caused by navigational drift.

Treatment of posterior urethral distractions defects following pelvic fracture

Posterior urethral injuries typically arise in the context of a pelvic fracture.Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected.Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first.Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected.Early diagnosis and proper acute management decrease the associated complications,such as strictures,urinary incontinence and erectile dysfunction.The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury.Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3e6 months continues to be the gold standard of treatment.In this paper,we provide a comprehensive review of the literature with a special emphasis on the various treatments available:Open or endoscopic primary realignment,immediate or delayed urethroplasty after suprapubic cystostomy,and delayed optical urethrotomy.

Multi-slice spiral computed tomography in diagnosing unstable pelvic fractures in elderly and effect of less invasive stabilization

BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.

Open pelvic fractures associated with anorectal injuries:emergency management strategies and risk factors for mortality

Objective To investigate emergency management strategies and risk factors for mortality of open pelvic fractures associated with anorectal injuries.Methods Between April 2001 to April 2010,25 patients of openpelvic fractures

Flap transplantation for treatment of pelvic fracture and defective hip

A case of flap transplantation for treatment of pelvic fracture and defective hip in the Third Affiliated Hospital of Inner Mongolia Medical University was collected and analyzed on the basis of diagnosis,physical examination and treatment.The patient was in serious condition with large necrotic area and prone to lead to various complications.The paper aims to share experience and provide references for similar cases amongst surgeons.

External fixator with lumbopelvic distraction spondylodesis for vertically unstable pelvic fracture

Objective To evaluate the clinical outcomes of external fixator with lumbopelvic distraction spondylodesis in treatment of vertically unstable pelvic fractures.Methods From January 2008 to March 2009,9 patients(4 males and 5 females)

Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

Preoperative virtual reduction method for pelvic fractures based on statistical shape models and partial surface data

Virtual reduction is crucial for successful and accurate reduction of pelvic fractures.Various methods have been proposed in this regard.However,not all of them are applicable to every pelvic fracture.Among these methods,the efficiency and accuracy of the method based on statistical shape models in clinical applications require further improvement.This study proposes a virtual reduction method for pelvic fractures that uses statistical shape models and partial surface data of a broken pelvis.Simulated fracture and clinical case experiments were conducted to validate the accuracy and effectiveness of the proposed method.The simulated fracture experiments yielded an average error of 1.57±0.39 mm and a maximum error of 12.82±3.54 mm.The virtual reduction procedure takes approximately 40 s.Based on three clinical case experiments,the proposed method achieves an acceptable level of accuracy compared with manual reduction by a surgeon.The proposed method offers the advantages of shorter virtual reduction times and satisfactory reduction accuracy.In the future,it will be integrated into the preoperative planning system for pelvic fracture reduction,thereby improving patient outcomes.

Effect of early restrictive fluid resuscitation on inflammatory and immune factors in patients with severe pelvic fracture

Purpose:To study the effect of early restrictive fluid resuscitation(EFR)on inflammatory and immune factors in patients with severe pelvic fracture(SPF).Methods:A total of 174 SPF patients in the Department of Orthopaedics,the First Affiliated Hospital of Chengdu Medical College from July 2015 to June 2018 were involved in this study and divided into EFR group(n=87)and control group(n=87)using the random number table method.Conventional fluid resuscitation(CFR)was performed in control group,and EFR was performed in EFR group.The incidences of acute respiratory distress syndrome(ARDS)and multiple organ dysfunction syndrome(MODS)during rescue,successful rescue rate,blood transfusion volume,fluid input,and resuscitation time were compared between the two groups.The parameters including prothrombin time(PT),hematocrit(HCT),platelet(PLT)and blood lactate(BL)at the 4th hour after fluid resuscitation were recorded.The levels of inflammatory factors(TNF-α,IL-6,CRP)and immune factors(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+)were compared between the two groups before treatment and 7 days after treatment.The revised acute physiologic and chronic health evaluation system and the sequential organ failure assessment scores were adopted for evaluation before treatment and 7 days after treatment.Results:The incidences of ARDS and MODS during rescue in EFR group were significantly lower than those in control group(p=0.015 and 0.010 respectively),and the successful rescue rate in EFR group was significantly higher than that in control group(p=0.011).The blood transfusion volume,fluid input,resuscitation time in EFR group were significantly lower than those in control group(p=0.016,0.002 and 0.001 respectively).At the 4th hour after fluid resuscitation,PT and BL in EFR group were significantly lower than those in control group(p=0.021 and 0.003 respectively),while HCT and PLT in EFR group were significantly higher than those in control group(p=0.016 and 0.021 respectively).On day 7 after treatment,TNF-α,IL-6,CRP and CD8^+in EFR group were significantly lower than those in control group(p=0.003,0.004,0.007 and 0.003 respectively),while CD3^+,CD4^+and CD4^+/CD8^+in EFR group were significantly higher than those in control group(p=0.004,0.000,0.007 respectively).On day 7 after treatment,the revised acute physiologic and chronic health evaluation(APACHE)system and the sequential organ failure assessment(SOFA)scores in EFR group were significantly lower than those in control group.Conclusion:EFR can effectively eliminate inflammatory factors,improve immune function,maintain the stability of blood components,reduce the incidences of ARDS and MODS,and elevate the successful rescue rate in patients with SPF.

The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures

Purpose:Hemodynamically unstable patients with pelvic fractures still represent a challenge to trauma surgeons and have a very high mortality.This study was designed to explore the effect of the interventions of direct preperitoneal pelvic packing for the hemodynamically unstable pelvic fractures.Methods:This retrospective study enrolled 67 cases of severe pelvic fractures with unstable hemodynamics from October 2011 to December 2019.All patients presented in our emergency center and received preperitoneal pelvic packing were included in this study.The indication was persistent systolic blood pressure90 mmHg during initial resuscitation and after transfusion of two units of red blood cells.Patients with hemodynamic stability who need no preperitoneal pelvic packing to control bleeding were excluded.Their demographic characteristics,clinical features,laboratory results,therapeutic interventions,adverse events,and prognostic outcomes were collected from digital information system of electronic medical records.Statistics were described as mean±standard deviation or medium and analyzed using pair sample t-test or Mann-Whitney U-test.Results:The patients’average age was 41.6 years,ranging from 10 to 88 years.Among them,45 cases were male(67.2%)and 22 cases were female(32.8%).Significant difference was found regarding the systolic blood pressure(mmHg)in the emergency department(78.4±13.9)and after preperitoneal pelvic packing in the surgery intensive care unit(100.1±17.6)(p<0.05).Simultaneously,the arterial base deficit(mmol/L)were significantly lower in the surgery intensive care unit(median-6,interquartile range-8 to-2)than in the emergency department(median-10,interquartile range-14 to-8)(p<0.05).After preperitoneal pelvic packing,15 patients(22.4%)underwent pelvic angiography for persistent hypotension or suspected ongoing haemorrhage.The overall mortality rate was 29.5%(20 of 67).Conclusions:Preperitoneal pelvic packing,as a useful surgical technique,is less invasive and can be very efficient in early intra-pelvic bleed control.

Surgical treatment of pelvic fracture urethral distraction defects in boys:which approach is suitable?

Pelvic fracture urethral distraction defects(PFUDDs)are relatively infrequent in boys,and treatment for PFUDDs presents one of the most difficult problems in urological practice.Anastomotic urethroplasty is considered an ideal surgical procedure for PFUDDs in boys.However,various surgical approaches for anastomotic urethroplasty have been proposed,including a simple transperineal approach,a tran sperineal in tercorporal septal separati on approach,a tran sperineal in ferior pubic approach,and a combined transpubic・perineal approach.This study aims to determine which surgical approach is best for PFUDDs in boys.We retrospectively identified 22 boys with PFUDDs aged 2-14 years who underwent anastomotic urethroplasty via different approaches between January 2008 and December 2017.Follow-up was performed in all the 22 patients for 6-123(mean:52.0)months.Finally,20 of the 22 boys(90.9%)were successfully treated,including 1 of 2 patients treated with a simple transperineal approach,3 of 3 with a transperineal approach with intercorporal septal separation,14 of 15 with a transperineal inferior pubic approach,and 2 of 2 with a combined transpubic-perineal approach.Two patients had failed outcomes after the operation,and stenosis recurred.Based on the outcome of the 22 patients,we can draw a preliminary conclusion that most boys(20/22)can be treated with a transperineal inferior pubic approach or simpler procedures without the need of completely removing or incising the pubis.The combined transpubic-perineal approach can be used in cases of extremely long urethral distract defects.

Is computed tomography cystography indicated in children with pelvic fractures?

Purpose: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images.Methods: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chisquare test and two-sided Fisher’s exact test. Ap value of less than 0.05 was considered statistically significant.Results: A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).Conclusion: The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.

Experimental and finite element analysis studies of a reduction-force reducing traction method for pelvic fracture surgeries

Pelvic fracture is among the most complicated fractures in traumatic orthopedics,with high mortality and morbidity rates.The main difficulty associated with the reduction surgery is significant muscle resistance.It then becomes necessary to decrease the reduction force against this strong muscle resistance,for improving surgical safety.Here,we propose a novel traction method for decreasing the reduction force during pelvic reduction,and investigate the performance of the elastic traction method on decreasing the reduction force using experimental tests and simulation-based analyses.From the experimental results,the reduction force decreased by 59.2%when 10 kg of elastic traction was applied.We also establish a musculoskeletal model of the pelvic fracture reduction,for analyzing the muscle resistance and the optimal traction force applied in reduction surgeries.The elastic traction method can counteract the muscle resistance increase in the non-traction direction owing to its flexibility.We conclude that the optimal traction force applied should be in the 10–15 kg range,and recommend adopting a dynamic traction strategy rather than continuous traction in clinical settings.Elastic traction is very promising for various surgeries that require traction,including pelvic reduction.It significantly reduces force,which can significantly reduce the physical exertion of the operating surgeon,the possibility of additional injuries to the operated patient,and promotes robot-assisted reduction surgeries.

Current trends in urethral stricture management

The recent International Consultation on Urological Disease(ICUD)panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis,as distinct from sphincter stenoses and a urethral disruption injury.Whenever possible,an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty.There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used,but clearly the extent of the spongiofibrosis and individual anatomical factors(the length of the penis and urethra)are important,the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee.More recently,there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique.Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps,as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results.It is important that the reconstructive surgeon is well versed in the full range of available repair techniques,as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.

Comparison of sexual function and quality of life after pelvic trauma with and without Angioembolization

Background:The aim is to study the safety of Angioembolization on long-term sexual function and quality of life.Methods:IRB approval was gained to review the prospectively collected trauma database as well as prospective questionnaires of patients at least 1 year out from pelvic fractures that occurred between 1996 and 2009.Surveys included the SF36v2,Female Sexual Function Index and the International Index of Erectile Function.Values for each domain were compared between patients treated with AE and 2:1 case-matched control patients as well as between the national norms.Values are presented as percentages or means with 95%CI.P<0.05 was considered statistically significant.Results:Thirty Seven cases and 74 matched controls were identified.42 patients completed the survey.There were 13 cases(12 males),and 29 controls(22 males).There was a higher ISS(Injury Severity Score)(32 vs 27;p=0.048)in the cases,but no difference in pelvic AIS(Abbreviated Injury Severity Score)(3 vs 3).Both groups scored similarly in the SF36 in all domains,but the entire cohort scored lower than the national norms in the physical functioning(41.9(37.8–46.0)vs50),role physical(40.9(36.2–45.7)vs50),body pain 43.8(40.7–46.9)vs50),role emotional 46.3(42.8–49.8)vs50),and physical composite score(42.1(38.0–46.3)vs50).All domains of the sexual function in both questionnaires showed significant impairment in our cohort compared with norms.Male cases had similar scores to the controls.Conclusion:Pelvic fractures portend a worse long-term QOL and sexual function than the general population.AE,however,does not have an additive affect to these indices.

A survey of emergency blunt urethral injury management in China:Reality versus guidelines

Background:Although urethral trauma may lead to serious consequences if mismanaged,treatment concepts are inconsistent.We designed a survey to investigate the current diagnosis and management of emergency blunt urethral trauma to aid future dissemination of relevant concepts.Methods:A 15‐item anonymous questionnaire was distributed via an online platform.It addressed items such as the cognition of how to diagnose of urethral trauma,optimal emergency management of a urethral trauma patient,and attitude towards early realignment for pelvic fracture urethral injuries.Results:Of 538 respondents,94.2%and 84.9%had received patients with straddle trauma urethral injuries or pelvic fracture urethral injuries,respectively,within the past year.In the emergency room,attempted urethral catheterization was the most selected examination method by respondents for diagnosis of both straddle injury(500/538)and pelvic fracture urethral injury(469/538).For patients with straddle injury,41.3%of respondents performed endoscopic realignment and 31.6%preferred suprapubic cystostomy.For hemodynamically stable patients with PFUI,42.2%of respondents preferred suprapubic cystostomy and 34.9%preferred endoscopic realignment.Most respondents felt favorably toward early realignment for pelvic fracture urethral injuries.After realignment,61.3%,24.5%,and 13.8%of respondents performed catheterization for 4,8,and 12 weeks,respectively.Further,54.6%of respondents believed catheter traction should be applied after realignment.Conclusion:Although the number of yearly emergency urethral trauma cases was small,the opinions and practices of most urologists were consistent with guidelines.However,the significance of retrograde urethrography was not fully understood,and some respondents had incorrect views on catheter traction after realignment.