Management of Urethral Injures. by Dr. Saad

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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

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