Pelvic fracture with complete urethrovaginal complex avulsion.

Abstract

The anatomic support of the urethra is controversial. We present a case of an intact urethra and vagina avulsing from the symphysis pubis after pelvic fracture. An 18-year-old female pedestrian was struck by a motor vehicle. Operative reevaluation revealed an intact vagina and urethra; however, they were avulsed from the symphysis pubis. The avulsed urethra and vagina were reapproximated to the periosteum and surrounding soft tissue circumferentially with no urogenital sequelae. Complete anterior vaginal wall avulsion may occur with sparing of the lower urinary tract in the setting of pelvic fracture. This case supports the current anatomic understanding of a strong and dense attachment between the urethra and the anterior vaginal wall.