URETHRAL INJURY IN RELATION TO FRACTURE PELVIS

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urethral injuries

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URETHRAL INJURY IN RELATION TO FRACTURE PELVIS:

URETHRAL INJURY IN RELATION TO FRACTURE PELVIS

Anatomy of Male Urethra:

Anatomy of Male Urethra

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Posterior urethra: Prostatic urethra Membranous urethra Anterior urethra: Bulbous urethra Pendulous urethra Fossa navicularis

Anatomy of female urethra:

Anatomy of female urethra

Male urethra in relation with Pelvic bone:

Male urethra in relation with Pelvic bone

Uretheral injuries in pelvic fractures:

Uretheral injuries in pelvic fractures In pelvic fracture membranous urethra is most common site that gets ruptured. As per Mouraviev and Santucci its membranobulbar junction Less common in females due to shorter length and higher mobility.

Etiology:

Etiology Most common causes of pelvic fractures are: road traffic Accidents Severe crush injuries Falls. Other causes of urethral injuries are direct blunt trauma to perineum like: Horse kick Manhole injury

Classicfication of Pelvic fractures:

Classicfication of Pelvic fractures

PowerPoint Presentation:

Straddle Malgaigne

Mechanism of urethral injury in pelvic fracture:

Mechanism of urethral injury in pelvic fracture Pokorny postulated 1. ( Malgaigne fracture)upward displacement of one hemipelvis and symphysis. (Straddle Fractures) whereby a free floating central symphyseal fragment is displaced posteriorly . The pubic symphysis diastasis , whereby the membranous urethra is stretched until it ruptures.

Site of injury:

Site of injury Mouraviev and Santucci . Dissection study of victims who died with known pelvic-fracture urethral-disruption injuries, seven out of 10 subjects were found to have disruption distal to the external urinary sphincter

Classification of urethral injury:

Classification of urethral injury Injury type Appearance 1 The posterior section of the urethra is stretched. Easily seen on urethrography and may be identified on CT by elevation of the prostatic apex 2 Posterior urethral injury with no involvement of the urogenital diaphragm 3 Posterior urethral injury with injury of the anterior urethra (crossing the urogenital diaphragm) 4 Bladder neck and proximal urethral injury 4a Bladder neck injury without urethral injury but with periurethral contrast 5 Anterior urethral injury only Goldman ‘s modification of Colapinto and McCallum

Clinical features:

Clinical features Urinary retention Blood at the urethral meatus Inability to void Inability to catheterize Perineal swelling High riding prostate on digital rectal examination

Management:

Management ?Try to cathetrize once with a 14 Fr soft foley’s catheter. Retro grade urethro gram Supra pubic cystostomy Primary repair Secondary repair

Retrograde urethrogram:

Retrograde urethrogram

Normal urethrogram:

Normal urethrogram

Primary repair:

Primary repair Koraitim MM of Alexendria University, Egypt   Primary suturing for disrupted urethral ends increases rates of incontinence and impotence (21 and 56%, respectively). Primary realignment double incidence of impotence and half that of stricture compared to suprapubic cystostomy and delayed repair (36 versus 19 and 53 versus 97%, respectively, p <0.0001).

Suprapubic cystomy:

Suprapubic cystomy

Urethroplasty :

Urethroplasty

PowerPoint Presentation:

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