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Letters to the Editor   |    
Spontaneous Urinary Voiding of a Metallic Implant After Operative Fixation of the Pubic Symphysis
Rudolf W. Poolman, MD; Martin J. Heetveld, MD; Eddy A. Heldeweg, MD; Jan M. Ultee, MD
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The authors did not receive grants or outside funding in support of their research or preparation of this work. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Mar 01;86(3):645-646
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To The Editor:With great interest, we read "Spontaneous Urinary Voiding of a Metallic Implant After Operative Fixation of the Pubic Symphysis. A Case Report" (2003;85:1129-32), by Fridman et al. We described a similar case of a patient who voided a screw nine years after internal fixation of diastasis of the pubic symphysis1. The Advanced Trauma Life Support program advises doctors to perform a retrograde urethrogram in patients in whom urologic injury is suspected2. Did the authors make a retrograde urethrogram or cystogram at presentation after the initial trauma to diagnose an injury to the ureter or bladder? In a review of urethral injuries after pelvic fractures in females, Perry and Husmann reported that 50% of urethral injuries were missed because of inadequate urologic assessment3. The initial bladder injury may have been caused by the trauma itself, but bladder herniation within the symphysis or iatrogenic injury are also possibilities4.
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