URETHRAL INJURIES & MANAGEMENT : URETHRAL INJURIES & MANAGEMENT
Anatomy : Anatomy Posterior urethra.
Prostatic
Membranous
2. Anterior urethra.
Bulbous
Pendolous
Slide 3: prostatic membranous pendulous bulbar
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
Palpapable bladder
Pelvic hematoma
Superiorly dispalced 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.
Stradle injuries→Laceration or Contusion
Self instrumentation or iatrogenic may cause partial disruption.
Symptoms & Signs : Symptoms & Signs Histry of fall
Local pain in perineum
History of instrumentation
Massive prineal hematom
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