Differential Diagnosis for Difficulty Voiding after Seat Belt Trauma

• Single Most Likely Diagnosis
  • Urethral injury or stricture: This is a common injury following blunt trauma to the pelvis, such as seat belt trauma, which can cause difficulty voiding due to obstruction or damage to the urethra.
• Other Likely Diagnoses
  • Hematoma or swelling in the pelvic area: Trauma can cause bleeding or fluid accumulation in the pelvic region, which may compress the urethra or bladder, leading to voiding difficulties.
  • Bladder injury or rupture: Although less common than urethral injuries, bladder damage can occur from seat belt trauma, especially if there was a full bladder at the time of the accident, leading to urinary retention or difficulty voiding.
  • Pelvic fracture: Fractures in the pelvic area can cause urethral or bladder injury, or the fracture itself can compress these structures, leading to difficulty voiding.
• Do Not Miss Diagnoses
  • Ruptured bladder with intraperitoneal leakage: This is a life-threatening condition where urine leaks into the abdominal cavity, requiring immediate surgical intervention. Missing this diagnosis could lead to severe infection, sepsis, and death.
  • Urethral disruption with complete transaction: A complete severing of the urethra is a medical emergency that requires prompt surgical repair to prevent long-term complications such as incontinence and sexual dysfunction.
  • Neurogenic bladder due to spinal cord injury: Although less common, seat belt trauma can be associated with spinal cord injuries, especially if there was a high-speed collision or significant force involved. Neurogenic bladder can lead to urinary retention or incontinence.
• Rare Diagnoses
  • Vesicoureteral reflux: Trauma can potentially cause or worsen vesicoureteral reflux, where urine flows backward from the bladder into the kidneys, which might indirectly cause voiding difficulties due to urinary tract infections or other complications.
  • Foreign body in the urethra: In rare cases, especially if there were penetrating injuries or if debris from the accident entered the urethra, a foreign body could cause an obstruction leading to difficulty voiding.
  • Psychogenic urinary retention: Psychological trauma from the accident could, in rare instances, lead to psychogenic urinary retention, where the individual has difficulty voiding due to psychological rather than physical reasons.