Etiology, patterns and short-term outcomes of lower urinary tract trauma in males admitted at Mbarara Regional Referral Hospital, Uganda

Etiology, patterns and short-term outcomes of lower urinary tract trauma in males admitted at Mbarara Regional Referral Hospital, Uganda | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Etiology, patterns and short-term outcomes of lower urinary tract trauma in males admitted at Mbarara Regional Referral Hospital, Uganda O Atwine, Racheal Ainomugisha, Marvin Mwesigwa, E Tayebwa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4163245/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Trauma poses a major public health challenge in Africa. This study was conducted to establish the etiology, patterns and short-term outcomes of patients with lower urinary tract trauma in males admitted at Mbarara Regional Referral Hospital Methods: This was a hospital based prospective cohort study done on participants with lower urinary tract trauma admitted at Mbarara Regional Referral Hospital for a period of eight months from December 2022 to July 2023. Results: A total of thirty-nine (38) male participants were consecutively selected and enrolled into the study. The over all median age was 25, interquartile range (5-37) years. A total of 50 lower urinary tract injuries were recorded. Urethra was the most injured organ at 70% (n=35). Injuries due to motor vehicle crush was the commonest cause of trauma at 52% (n=26). Urethral complete tear was the most common urethra injury pattern at 62.9% (n=22) while bladder contusion was the commonest bladder injury pattern at 60% (n=9). Anterior urethra was the most injured part at 60.0% (n=21). Overall complication stood at 57.9% (n=22) with urethral bleeding being the commonest at 36.8 % (n=14). Most patients stayed in the hospital longer than one week 65.8% (n=25). Mortality was 5.3% (n=2). Conclusion: Motor vehicle crush is the leading cause of lower urinary tract trauma in males; urethra is the most injured organ and urethra bleeding is the commonest complication following treatment. Overall mortality is low. lower urinary tract trauma etiology patterns outcomes Figures Figure 1 Figure 2 Introduction Lower urinary tract trauma (LUTT) includes injury to the urinary bladder and urethra ( 1 ). Anatomically, the whole urinary tract system is usually protected from external forces, however its diagnosis remains a challenge especially in a poor resourced setting( 2 ). In United States, urinary system is a significant contributor to trauma induced morbidity and mortality accounting for 10% of 2.8 million people hospitalized annually due to trauma( 3 ). In Africa, a study done in Sub-Saharan Africa indicates that of the patients admitted with urological emergences, LUTT accounted for 88.4%( 4 ). In children, lower urinary tract injuries accounted for 7% of all injuries and most of them were accompanied by potentially fatal conditions such as brain, chest and abdominal injuries( 5 ). In Nigeria, blunt trauma due to motor vehicle crush (MVC) is the commonest cause 50% of lower urinary tract injuries while gunshot accounted for most penetrating injuries( 6 ). In pediatric population, circumcision was the commonest cause of urological injuries followed by MVC due to commercial motorcycles( 5 ) These injuries usually occur in the background of polytrauma and may easily be overlooked, hence leading to under-reporting, miss management and complications such as bleeding, infection if not treated well( 7 ). Therefore, this study aims to describe the etiology, patterns and short-term outcomes of males with lower urinary tract trauma admitted at MRRH. Participants and methods A prospective cohort study, of participants with LUTT admitted to the department of surgery of Mbarara Regional Referral Hospital between 1st December 2022 to 31st July 2023 was undertaken. Mbarara Regional Referral Hospital is a government owned referral and teaching hospital. The Hospital is situated along the Kampala-Kabale highway. MRRH serves a population of around four million people. An interviewer-administered pre-coded questionnaire was used for data collection. Where necessary, a review of patient’s medical records for example referral form was done. For all patients who underwent surgery for the lower urinary tract injuries, details were obtained from operation notes in liaison with surgical team. Results The median age was 25 years, with interquartile range (5–37) years. Majority of the participants were peasants (n = 25, 65.8%). Most participants attained primary education (n = 20, 52.6%). Details, see Table 1 MVC were most common etiology of LUTT (n = 26, 52%) followed by iatrogenic injuries (n = 12, 24%). Details, see Fig. 1 Urethra was the most injured LUT organ (n = 35, 70%). Urethra complete tear was the most common urethra injury pattern (n = 22, 62.9%). Details, see Fig. 2 and Table 2 Majority of the participants were discharged home (n = 36, 97.4%), mortality was 5.3% (n = 2). Average length of hospital stay was more than 1 week (n = 25, 65.8%). Generally, complication rate following treatment was high (n = 25, 64.1%) and urethra bleeding was the commonest complication (n = 14, 36.8%). Details, see Table 3 Table 1 Distribution of participants by social demographics Variable Frequency (n) Percentage (%) Age (median/IQR) 25 (5–37) Occupation Peasant farmer 25 65.8 Not working 9 23.7 Student 4 10.5 Level of education Not of age 9 23.7 Primary 20 52.6 Secondary 6 15.8 Tertiary 3 7.9 Marital status Not of age 7 18.4 Single 25 65.8 Married 4 10.5 Divorced 3 7.9 Table 2 Injury patterns of genital organs Organ Frequency (n) Percentage (%) Urinary bladder Intra-peritoneal rupture 6 40 Bladder contusion 9 60 Urethra Complete tear 22 62.9 Partial tear 9 25.7 Contusion 4 11.4 Location of urethra injury 19.1 Anterior 21 60.0 Posterior 14 40.0 Table 3 Outcomes of treatment of lower urinary tract trauma Variable Frequency (n) Percentage (%) Patient disposition Discharge 36 94.7 Ran away 0 0 Died 2 5.3 Length of hospital stay < 1 week 13 34.2 2 weeks 5 13.2 Complications Infection 2 5.3 Urethral Bleeding 14 36.8 Urine retention 6 15.8 No complication 16 42.1 Discussion 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 Conclusions Motor vehicle crush due to motorcycle transport system is the leading cause of lower urinary tract trauma. Urethra is the most injured organ and urethra bleeding is the commonest complication following treatment. Mortality is low in lower urinary tract injuries and is always associated with other vital organ injuries. These injuries are usually hidden and hence every trauma patient, should be screened for urological injuries. Abbreviations LUTT Lower Urinary Tract Trauma MRRH Mbarara Regional Referral Hospital MUST Mbarara University of Science and Technology MVC Motor Vehicle Crush PI Principal Investigator WHO World Health Organization REC Research Ethical Committee USA United States of America Declarations Ethical approval and Consent to participate Written informed consent and assent to participate in the study, was sought from study participants, after approval from Mbarara University of Science and Technology-Research Ethical Committee (REC). A copy of the consent, assent and approval is available for review by the Editor-in-Chief of this journal on request. Consent for publication Not applicable Competing interests The authors report no competing interests in this work Funding This research manuscript did not receive any specific grant from funding agencies in public, commercial, or not for profit sectors. Author Contribution O.A managed the patient and wrote the first draft. M.M.M were involved in patient management, review and editing of the paper, R.A and E.T critically revised and edited the manuscript. All authors approved the final manuscript submitted. Acknowledgments I give thanks to the members of staff in the Department of Surgery-MUST, my supervisors, my family and the participants in this study. Availability of data and materials The datasets used and/or analysed during the study, are available from the corresponding author on reasonable request References Tullington JE, Blecker N. Lower Genitourinary Trauma2020. Salako AA, Adisa AO, Eziyi AK, Banjo OO, Badmus TA. Traumatic urologic injuries in ile-ife, nigeria. J emergencies trauma shock. 2010;3(4):311. McGeady JB, Breyer BN. Current Epidemiology of Genitourinary Trauma. Urol Clin North Am. 2013;40(3):323–34. Cassell Iii AK, Manobah B. Management of genitourinary trauma–current evaluation from the Sub-Saharan region: A systematic review. World J Crit care Med. 2021;10(6):377. Osuigwe A, Ekwunife C, Ndukuwu C, Edokwe E. Paediatric Urological Trauma at Nnewi, South Eastern Nigeria: A Two-Year Experience. Afr J Urol. 2003;9(2):102–5. Zinman LN, Vanni AJ. Surgical management of urologic trauma and iatrogenic injuries. Surg Clin. 2016;96(3):425–39. Oluoch CO. Pattern of Genitourinary Tract Injuries in Patients With Multiple Trauma. at the Kenyatta National Hospital: UON; 2021. Oranusi C, Nwofor A. Traumatic penile injuries: Mechanisms and problems of treatment in a tertiary institution in Nigeria. Niger J Clin Pract. 2014;17(6):763–6. Ahmed A, Mbibu N. Aetiology and management of injuries to male external genitalia in Nigeria. Injury. 2008;39(1):128–33. Brant W, Bella A, Gracia M, Lue T, Priapism. Emergencies in Urology: Springer; 2007. p. 301–12. Phillips B, Holzmer S, Turco L, Mirzaie M, Mause E, Mause A, et al. Trauma to the bladder and ureter: a review of diagnosis, management, and prognosis. Eur J Trauma Emerg Surg. 2017;43(6):763–73. Patel AB, Osterberg EC, Satarasinghe PN, Wenzel JL, Akbani ST, Sahi SL, et al. Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians. J Clin Med. 2023;12(4):1495. Najibi S, Tannast M, Latini JM. Civilian gunshot wounds to the genitourinary tract: incidence, anatomic distribution, associated injuries, and outcomes. Urology. 2010;76(4):977–81. Djè K, Yao B, Sanou B, Kokoua A, Gnananzan K. Genitourinary complications of pelvic traumaLes complications uro-génitales des traumatismes du bassin: a propos de 41 cas. Afr J Urol. 2006;12(1):37–43. McCormick CS, Dumais MG, Johnsen NV, Voelzke BB, Hagedorn JC. Male genital trauma at a level 1 trauma center. World J Urol. 2020;38:3283–9. Phillips EA, Esposito AJ, Munarriz R. Acute penile trauma and associated morbidity: 9-year experience at a tertiary care center. Andrology. 2015;3(3):632–6. Additional Declarations No competing interests reported. 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Anatomically, the whole urinary tract system is usually protected from external forces, however its diagnosis remains a challenge especially in a poor resourced setting(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In United States, urinary system is a significant contributor to trauma induced morbidity and mortality accounting for 10% of 2.8\u0026nbsp;million people hospitalized annually due to trauma(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Africa, a study done in Sub-Saharan Africa indicates that of the patients admitted with urological emergences, LUTT accounted for 88.4%(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In children, lower urinary tract injuries accounted for 7% of all injuries and most of them were accompanied by potentially fatal conditions such as brain, chest and abdominal injuries(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Nigeria, blunt trauma due to motor vehicle crush (MVC) is the commonest cause 50% of lower urinary tract injuries while gunshot accounted for most penetrating injuries(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In pediatric population, circumcision was the commonest cause of urological injuries followed by MVC due to commercial motorcycles(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThese injuries usually occur in the background of polytrauma and may easily be overlooked, hence leading to under-reporting, miss management and complications such as bleeding, infection if not treated well(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, this study aims to describe the etiology, patterns and short-term outcomes of males with lower urinary tract trauma admitted at MRRH.\u003c/p\u003e"},{"header":"Participants and methods","content":"\u003cp\u003e A prospective cohort study, of participants with LUTT admitted to the department of surgery of Mbarara Regional Referral Hospital between 1st December 2022 to 31st July 2023 was undertaken. Mbarara Regional Referral Hospital is a government owned referral and teaching hospital. The Hospital is situated along the Kampala-Kabale highway. MRRH serves a population of around four million people. An interviewer-administered pre-coded questionnaire was used for data collection. Where necessary, a review of patient\u0026rsquo;s medical records for example referral form was done. For all patients who underwent surgery for the lower urinary tract injuries, details were obtained from operation notes in liaison with surgical team.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe median age was 25 years, with interquartile range (5\u0026ndash;37) years. Majority of the participants were peasants (n\u0026thinsp;=\u0026thinsp;25, 65.8%). Most participants attained primary education (n\u0026thinsp;=\u0026thinsp;20, 52.6%). \u003cb\u003eDetails, see\u003c/b\u003e Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003eMVC were most common etiology of LUTT (n\u0026thinsp;=\u0026thinsp;26, 52%) followed by iatrogenic injuries (n\u0026thinsp;=\u0026thinsp;12, 24%). \u003cb\u003eDetails, see\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003eUrethra was the most injured LUT organ (n\u0026thinsp;=\u0026thinsp;35, 70%). Urethra complete tear was the most common urethra injury pattern (n\u0026thinsp;=\u0026thinsp;22, 62.9%). \u003cb\u003eDetails, see\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003eand\u003c/b\u003e Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003eMajority of the participants were discharged home (n\u0026thinsp;=\u0026thinsp;36, 97.4%), mortality was 5.3% (n\u0026thinsp;=\u0026thinsp;2). Average length of hospital stay was more than 1 week (n\u0026thinsp;=\u0026thinsp;25, 65.8%). Generally, complication rate following treatment was high (n\u0026thinsp;=\u0026thinsp;25, 64.1%) and urethra bleeding was the commonest complication (n\u0026thinsp;=\u0026thinsp;14, 36.8%). \u003cb\u003eDetails, see\u003c/b\u003e Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of participants by social demographics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (median/IQR) 25 (5\u0026ndash;37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant farmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot of age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot of age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInjury patterns of genital organs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrgan\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary bladder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-peritoneal rupture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBladder contusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrethra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of urethra injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutcomes of treatment of lower urinary tract trauma\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient disposition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDischarge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRan away\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of hospital stay\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrethral Bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine retention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLower 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.\u003c/p\u003e \u003cp\u003eIn 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(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). 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(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInjury 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\u0026thinsp;=\u0026thinsp;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 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) \u0026amp; (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). 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\u0026thinsp;=\u0026thinsp;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(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). 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(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLower urinary tract trauma includes injuries to the urinary bladder and the urethra. In this study, urethra was the most injured organ (n\u0026thinsp;=\u0026thinsp;35, 70%). This is similar to the studies done in Kenya in which urethral injury accounted for 51.9%(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This could be explained by similar etiology in MVC due to motorcycle transport system was the commonest cause.\u003c/p\u003e \u003cp\u003eIn 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 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This could have been explained by similar etiologies of bladder injuries in which MVC was the commonest cause.\u003c/p\u003e \u003cp\u003eIn 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 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFollowing 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\u0026thinsp;=\u0026thinsp;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%(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). 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\u0026rsquo;lvoire at 34%(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBleeding 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%(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)and 32%(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). 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\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eMotor vehicle crush due to motorcycle transport system is the leading cause of lower urinary tract trauma. Urethra is the most injured organ and urethra bleeding is the commonest complication following treatment. Mortality is low in lower urinary tract injuries and is always associated with other vital organ injuries. These injuries are usually hidden and hence every trauma patient, should be screened for urological injuries.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLUTT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLower Urinary Tract Trauma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMRRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMbarara Regional Referral Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMUST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMbarara University of Science and Technology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMVC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMotor Vehicle Crush\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePrincipal Investigator\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eREC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eResearch Ethical Committee\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited States of America\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthical approval and Consent to participate\u003c/h2\u003e \u003cp\u003eWritten informed consent and assent to participate in the study, was sought from study participants, after approval from Mbarara University of Science and Technology-Research Ethical Committee (REC). A copy of the consent, assent and approval is available for review by the Editor-in-Chief of this journal on request.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors report no competing interests in this work\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research manuscript did not receive any specific grant from funding agencies in public, commercial, or not for profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eO.A managed the patient and wrote the first draft. M.M.M were involved in patient management, review and editing of the paper, R.A and E.T critically revised and edited the manuscript. All authors approved the final manuscript submitted.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eI give thanks to the members of staff in the Department of Surgery-MUST, my supervisors, my family and the participants in this study.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analysed during the study, are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTullington JE, Blecker N. Lower Genitourinary Trauma2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalako AA, Adisa AO, Eziyi AK, Banjo OO, Badmus TA. Traumatic urologic injuries in ile-ife, nigeria. J emergencies trauma shock. 2010;3(4):311.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGeady JB, Breyer BN. Current Epidemiology of Genitourinary Trauma. Urol Clin North Am. 2013;40(3):323\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCassell Iii AK, Manobah B. Management of genitourinary trauma\u0026ndash;current evaluation from the Sub-Saharan region: A systematic review. World J Crit care Med. 2021;10(6):377.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsuigwe A, Ekwunife C, Ndukuwu C, Edokwe E. Paediatric Urological Trauma at Nnewi, South Eastern Nigeria: A Two-Year Experience. Afr J Urol. 2003;9(2):102\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZinman LN, Vanni AJ. Surgical management of urologic trauma and iatrogenic injuries. Surg Clin. 2016;96(3):425\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOluoch CO. Pattern of Genitourinary Tract Injuries in Patients With Multiple Trauma. at the Kenyatta National Hospital: UON; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOranusi C, Nwofor A. Traumatic penile injuries: Mechanisms and problems of treatment in a tertiary institution in Nigeria. Niger J Clin Pract. 2014;17(6):763\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed A, Mbibu N. Aetiology and management of injuries to male external genitalia in Nigeria. Injury. 2008;39(1):128\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrant W, Bella A, Gracia M, Lue T, Priapism. Emergencies in Urology: Springer; 2007. p. 301\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhillips B, Holzmer S, Turco L, Mirzaie M, Mause E, Mause A, et al. Trauma to the bladder and ureter: a review of diagnosis, management, and prognosis. Eur J Trauma Emerg Surg. 2017;43(6):763\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel AB, Osterberg EC, Satarasinghe PN, Wenzel JL, Akbani ST, Sahi SL, et al. Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians. J Clin Med. 2023;12(4):1495.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNajibi S, Tannast M, Latini JM. Civilian gunshot wounds to the genitourinary tract: incidence, anatomic distribution, associated injuries, and outcomes. Urology. 2010;76(4):977\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDj\u0026egrave; K, Yao B, Sanou B, Kokoua A, Gnananzan K. Genitourinary complications of pelvic traumaLes complications uro-g\u0026eacute;nitales des traumatismes du bassin: a propos de 41 cas. Afr J Urol. 2006;12(1):37\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCormick CS, Dumais MG, Johnsen NV, Voelzke BB, Hagedorn JC. Male genital trauma at a level 1 trauma center. World J Urol. 2020;38:3283\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhillips EA, Esposito AJ, Munarriz R. Acute penile trauma and associated morbidity: 9-year experience at a tertiary care center. Andrology. 2015;3(3):632\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"lower urinary tract trauma, etiology, patterns, outcomes","lastPublishedDoi":"10.21203/rs.3.rs-4163245/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4163245/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Trauma poses a major public health challenge in Africa. This study was conducted to establish the etiology, patterns and short-term outcomes of patients with lower urinary tract trauma in males admitted at Mbarara Regional Referral Hospital\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis was a hospital based prospective cohort study done on participants with lower urinary tract trauma admitted at Mbarara Regional Referral Hospital for a period of eight months from December 2022 to July 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of thirty-nine (38) male participants were consecutively selected and enrolled into the study. The over all median age was 25, interquartile range (5-37) years. A total of 50 lower urinary tract injuries were recorded. Urethra was the most injured organ at 70% (n=35). Injuries due to motor vehicle crush was the commonest cause of trauma at 52% (n=26). Urethral complete tear was the most common urethra injury pattern at 62.9% (n=22) while bladder contusion was the commonest bladder injury pattern at 60% (n=9). Anterior urethra was the most injured part at 60.0% (n=21). Overall complication stood at 57.9% (n=22) with urethral bleeding being the commonest at 36.8 % (n=14). Most patients stayed in the hospital longer than one week 65.8% (n=25). Mortality was 5.3% (n=2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Motor vehicle crush is the leading cause of lower urinary tract trauma in males; urethra is the most injured organ and urethra bleeding is the commonest complication following treatment. Overall mortality is low.\u003c/p\u003e","manuscriptTitle":"Etiology, patterns and short-term outcomes of lower urinary tract trauma in males admitted at Mbarara Regional Referral Hospital, Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-01 16:41:42","doi":"10.21203/rs.3.rs-4163245/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aabae854-82dc-4104-9021-5911ff0fc0a0","owner":[],"postedDate":"April 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-03T07:45:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-01 16:41:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4163245","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4163245","identity":"rs-4163245","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}