Die Verletzung der hinteren Harnröhre

Abstract

Injuries of the posterior urethra are a result of a blunt trauma of the pelvic ring, lacerations of the perineum and iatrogenic perforations due to transurethral manipulations. Traumatic lesions of the posterior urethra in about 10% of these patients suffer also a bladder laceration. The diagnosis of a urethral injury is ascertained by i. v. urogram and urothrography. If a urethral trauma is suspected the insertion of a catheter should be avoided in any case. The treatment is divided in emergency treatment, which means evacuation and drainage of the haematoma and extravasation and suprapubic urinary derivation made by the surgeon and the primary realignment or delayed urethral reconstruction, both interventions being reserved for well trained urologists. Minimal lesions characterized by a preserved continuity in small extravasations in the urothrography are sufficiently treated by a suprapubic urinary diversion. Severe injuries are treated by realignment of the urethra over a splint, drainage of the perivesical space and urinary diversion. 63% of the patients treated by this modality had perfect results and there was no need for further therapy. The proper replacement of the fractured pelvic bones are an integrated part of our plan of treatment. About 12% of patients with pelvic fracture and injury of the posterior urethra experience loose their potency. These can be explained by neurovascular injury. Impotence does not seem to be caused by surgical treatment, since the rate of impotence is similar in patients treated by primary realignment and suprapubic urinary diversion only.