Management of Urethral Injures presented by: dr saad : Management of Urethral Injures presented by: dr saad
PowerPoint Presentation: How Urethral Injuries happen?
PowerPoint Presentation: 90 % of posterior Urethral injuries ( Moter vehicle accidents ) 10% of posterior Urethral injuries (fall, Crush Injuries, or sporting Injuries). Anterior Urethral injuries (Straddle injuries) Fall astride a fence, Kicks, Bicycle injuries
Signs & Symptoms : Symptoms: Inability to void Sensation of voiding without passing urine Blood at the urinary meatus Gross Hematuria Signs & Symptoms
Signs: Swelling and ecchymosis : Penis scrotum and perineum DRE Finding: Upward displacement of prostate Boggy mass Signs
Imaging: Retrograde Urethrography X-ray Pelvis Urethral Injury Scale Imaging Grade Injury Description I: Contusion Blood at urethral meatus ; urethrography normal II: Stretch Injury Elongation of urethra without extravasation on urethrography III: Partial Disruption Extravasation of urethrographic contrast medium at injury site, with contrast visualized in the bladder IV: Complete disruption Extravasation of urethrographic contrast medium at injury site, without contrast visualized in the bladder; <2 cm separation V: Complete disruption Extravasation of urethrographic contrast medium at injury site, without contrast visualized in the bladder; >2 cm separation
Treatment: Anterior Urethral Injury Grade I& II: Conservative Management Catherization (if not able to void) Grade III: Flouroscopic Catherization Grade IV& V: Suprapubic Catherization followed by delayed urethroplasty Treatment
Penetrating Injuries of anterior Urethra: Exploration and Primary repair or suprapubic cathetrization . Hematoma: Suprapubic Cathetrization and Urethral reconstruction after 3 months. Penetrating Injuries of anterior Urethra
Posterior Urethral Injuries : Grade I& II: Conservative Management Catherization (if not able to void) Grade III: Flouroscopic Catherization ( suprapubic catherization if flouroscopy fails) Grade IV & V: Surgical repair with anastomosis of the disrupted urethral ends. Delayed primary repair. Primary surgical catheter realignment. Primary endoscopic realignment with imaging. Suprapubic systostomy with delayed urethroplasty . Posterior Urethral Injuries
Primary Surgical Repair: Evacuation of Pelvic Hematoma Mobilization of the Prostate and Urethra ETE of Prostatic and membranous urethra. Hazards Bleeding Future incontinence Impotance Primary Surgical Repair
Suprapubic cystostomy with delayed urethroplasty: No evacuation of Hematoma Hazards Infection Stoneformation Stricture formation (Nearly 100%) Suprapubic cystostomy with delayed urethroplasty
Studies Results: Koraitin reviewed and compare deferent surgical technique. Studies Results
More recent Studies:: Comparison between primary alignment and suprapubic cystostomy favours early primary alignment because a reduces the risk of 50%. More recent Studies:
Urethral Trauma in girls: Reair Distal Evulation from perineal attachment Leceration Ureththroscopy is the preferred diagnosis. Urethral Trauma in girls
Treatment: Meticulous repair with reaproximation of the bladder outlet and urethra. Cush injury not involving the bladder is manage with extended catherization (6-8 weak) or suprapubic diversion. Complication Stenosis , Urethrovaginal fistula Incontinence Vaginal stenosis Treatment