urethra

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URETHRA:

URETHRA

Urethra :

Urethra Female ~ 4cm long opens to exterior between clitoris and vaginal opening Male ~ 20 cm long passes through prostate gland pierces urogenital diaphragm enters penis and extends throughout length opens at urethral orifice

The Female Urethra:

The Female Urethra A 4-cm muscular tube in females Inner longitudinal and outer circular musculature Both muscles are connecting with the detrusor Surrounded by striated skeletal muscle – external sphincter, in an omega shape Pelvic floor muscles

The Female Urethra:

The Female Urethra Mucosa is transitional epithelium, becoming stratified squamous toward meatus Submucosa is very vascular Innervated by parasympathetic cholinergic fibers and sympathetic alpha-adrenergic fibers Abundant nitric oxide synthase in smooth muscle and striated muscles

The Male Urethra:

The Male Urethra Striated external sphincter bulk around membranous urethra and extend over apex of prostate, especially anteriorly. Contains slow twitch (35%)-sustained tonus, fast twitch fatigable fibers (50%), and fast twitch fatigue resistant (15%)- for emergency. External sphincter is about 1 inch long and 6 mm deep

Parts :

Parts Posterior urethra. Prostatic Membranous 2 . Anterior urethra. Bulbous Pendolous prostatic membranous bulbar pendulous

Posterior urethral injuries.:

Posterior urethral injuries . Posterior urethra injured in 1.6 -9.9% of pelvic fracture. Complete: 73% Partial: 27%

Causes.:

Causes. Shearing force. Direct laceration by pelvic bone fragment. Distraction,caused by pelvic fracture b/w pubic symphysis & pubic rami.

Symptoms and Signs:

Symptoms and Signs Blood at the urethral meatus. Do not, do not, do not try to pass the catheter if it’s present!!! Inability to urinate Palpable bladder Pelvic hematoma Superiorly displaced prostate

Diagnosis:

Diagnosis Immediate retrograde urethrogam.

Posterior urethra laceration:

Posterior urethra laceration

Posterior urethra –complete tear:

Posterior urethra –complete tear

Treatment:

Treatment Suprapubic cystostomy (Initial treatment) If incomplete laceration – spontaneous healing in 2-3 weeks Complete laceration – reconstruction after 3 months Primary repair – not recommended. Surgery is difficult because of hematomas.

Complications.:

Complications. Stricture: Primary repair →50% Delayed repair→ 5% 2. Impotence: Primary repair →30-80% Delayed repair →30-35% 3. Incontinence: <2% pts Typically ass:with sacral fracture & S2-S4 nerve injury.

Anterior Urethral Injuries:

Anterior Urethral Injuries Causes. Straddle injuries → Laceration or Contusion Self instrumentation or iatrogenic may cause partial disruption.

Symptoms & Signs:

Symptoms & Signs History of fall Local pain in perineum History of instrumentation Massive perineal hematoma Butterfly sign(hematoma)

Treatment:

Treatment Contusion:.if no extravasion urethra intact,after urethrography pt:allowed to void if ok no addional treatment. If bleeding present urethral cathetar can be done. Laceration:.S /P cystostomy →14-21 days Urethral cathhetar avoided bcz it converts incomplete tear to complete one. Pts : who develops complete oclusion of urethra should have S/P for 3-6 months before definite repairs.

THANKS:

THANKS

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