urology

Male urethral injuriesbladder injury

Dr,mohamed fawzi alshahwani

Urethral injury divided into Anterior Urethral injury posterior Urethral injury

Anterior urethral injurybulbar urethral injury
Causes blow to the perineum Stradal injury: cycling,loose manhole covers

Clinical features

Suspect urethral injury after blunt perineal trauma when; The man goes into retention There is perineal swelling butterfly hematoma Theres blood at urethral meatus

Treatment

Once urethral injury is suspected Dont allaw the patient to urinate Dont insert a foleys cathter unless after doing retrograd urethrography Accordingly the injury can be divided into


Contusion the dye pass to bladder ,no exravasation 2,Partial rupture the dye pass to bladder ,with exravasation 3,Compleate rupture the dye did not pass to bladder ,with exravasation


Retrograde ureththrography showAntrior partial urethral injury

Treatment

Contusion analgesic and antibiotic Partial and compleat rupture suprapubic cystostomy analgesic and antibiotic after 3 weeks retrograde urethrography done to asses the urethra,usually there will be a stricture which should be treated by dilatation,or urethrotomy,or urethroplasty

Posterior urethral injyrymembranous urethral injury

Intra pelvic rupture of membranous urethra occure near the apex of prostate Most comonlly deu to blunt trauma withe pelvic fracture

Posterior urethral injury

Clinical picture
History or trafic accident,fall Blood at external urethral meatus There may be associated injury to head,chest,abdomin,fracture of long bones,which may take priority in management to keep the pationt a live

Clinical picture,cont

KUB usually there is pubic bone fracture PR examination very high prostate, pelvic hematoma Retrograde urethrography extravasation of dye

Treatment

ABC Espicially when there is multiple injury Suprapubic cystostomy should be formal type when associated intraperitoneal bladder injury is suspected to repair the bladder at the same time Some surgion prefer rail roading method to realign the seperated urethral ends after 6 to 8 weeks asses the uretha by urethrography or urethroscopy

Complication of post urethral injury

Urethral stricture 2: urinary incontinence 3; impotence

Bladder injuries

Causes Peroperative TURP..TURBT,,cystolitholapaxy,cystoscopic bladder biobsy,caeserean section, blunt pelvic trauma, Penitrating trauma

Types of perforation

Intraperitoneal perforation the urine escape to the peritoneal cavity Extraperitoneal perforation the urine escape into the space around the bladder

Diagnosis

If injury occure During endoscopic operation the diagnosis is clear on visual inspiction alone,adark hole or loop of bowel is seen


In case of blunt trauma The classicall symtoms and sign are suprapubic pain and tenderness in ability to pass urine haematuria these sign and symtoms are indication for retrograde cystography

Retrograde cystogram

300 to 400 cc of contrast is ingecteto the bladder and film is takin then another film post evacuation is takin In intra peritoneal perforation loop of bowel may be out line by the contrast In extraperitoneal perforation the cotrast is limitted to immediate area surrounding the bladder

Intra peritonial extraperitonial

Treatment
Extraperitoneal Blader drainage with a urethral drainage for 2 weeks followed by cystogram to conferm healing of perforation Indication for surgical repair 1 a bone spike protruding to the bladder 2 associated rectal or vaginal perforation

Intraperitoneal

Usuqlly repqired surgicqlly to prevent complications from leakage of urine to the peritoneal cavity