URETHRAL INJURIES

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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

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