Interventional Radiology-Guided Foley Catheterization for Pelvic Fracture with Urethral Injury: A Single-Center Retrospective Case Series

Background/Objectives: In male trauma patients suspected of having a pelvic fracture with urethral injury (PFUI), repeated urethral catheterization attempts can cause additional injury. Since 2021, our institution has been performing simultaneous percutaneous cystostomy using a guidewire and anterograde urethral Foley catheter insertion during pelvic angiography in patients with suspected PFUI. We aimed to analyze the characteristics and clinical course of this patient group. Methods: We retrospectively analyzed male trauma patients who were admitted to our emergency department between January 2021 and December 2025, and who underwent the aforementioned interventional procedure after standard Foley catheterization failed because of a pelvic fracture-associated urethral injury. The age, mechanism of injury, injury severity score (ISS), abbreviated injury scale, type of pelvic fracture, use of pelvic angiography, time from emergency room arrival to Foley catheterization, and administration of additional urological treatments were investigated. Results: Among 492 male patients with pelvic fractures, 11 underwent the procedure because of PFUI (age: 57.8 ± 13.9 years, ISS: 20.2 ± 9.6). Pelvic crushing was the most common injury mechanism, and pelvic angiography was performed in 81.8% of cases. The mean time from emergency room arrival to interventional Foley catheterization was 283 ± 250 min. Three patients required additional urological treatment after the acute phase, and all underwent endoscopic internal urethrotomy for urethral stricture. Conclusions: In cases in which hemodynamically unstable PFUI is suspected and initial urethral catheterization is difficult, Foley catheter insertion via interventional radiology may represent an alternative to conventional primary endoscopic realignment and suprapubic cystostomy.