Rupture Of Posterior Urethra Research Articles

Experience of operative therapy in fresh rupture of posterior urethra

目的 探讨外科几种不同术式对新鲜后尿道断裂伤的治疗作用,判断临床疗效.方法 35例新鲜后尿道裂伤的病例,行尿道会师术、膀胱造瘘术、尿道断端吻合术、膀胱会阴部贯穿牵引固定术.结果疗效优良19例(54.3%),较好7例(20%),较差9例(25.7%).结论早期行尿道断端吻合术或膀胱会阴部贯穿牵引,能很好恢复尿道的连续性,尿道对位好,效果确切.单纯尿道会师术或膀胱造瘘术,临床效果欠佳。

La voie périnéo-trans-symphysaire dans le traitement des ruptures traumatiques de l’urètre postérieur

Objective – To study the place of the perineal-trans-pubic approach in the treatment of the posterior urethral post-traumatic rupture operated late, and to evaluate its results. Patients and methods – Twenty-four patients whose had a total posterior urethral post-traumatic rupture were treated in our department in a stage of urethral strictures. All patients underwent perineal transpubic urethroplasty. In this study we detailed a technique description of the approach and a clinical evaluation of our results. Results – This technique allows having a direct approach of the posterior urethra, to perform a tension free end to end urethral suture. The backward is about 3 years. We assessed 3 cases of recurrent urethral strictures. The cases of erectil dysfunction assessed were mainly related to the initial pelvic trauma. Finally this approach had not orthopaedic squall in all cases. Conclusions – Comparing to others, the perineal transpubic approach is the best one to manage the posterior urethral injuries treated with late. It gives a satisfactory results with a few disadvantages.

1-STAGE DELAYED BULBOPROSTATIC ANASTOMOTIC REPAIR OF POSTERIOR URETHRAL RUPTURE: : 60 PATIENTS WITH 1-YEAR FOLLOWUP

The long-term results of delayed 1-stage bulboprostatic anastomotic urethroplasty for posterior urethral ruptures are evaluated. A total of 63, 1-stage delayed repairs of complete posterior urethral ruptures in 60 men with at least 1-year followup were reviewed. Two ruptures were due to gunshot wounds and 58 were secondary to a pelvic fracture. There were 58 repairs done by the perineal approach and 5 required an abdominal perineal approach. Surgical complications included 2 (3%) rectal injuries, 3 (5%) repeat strictures that required reoperation and 20 (32%) repeat strictures that required dilation or visual internal urethrotomy. By 1 year after surgery all patients had a patent urethra and did not require further treatment. At 1 year 43 (72%) patients voided normally, 5 (8.3%) were areflexic and performed self-catheterization, 5 (8.3%) had urge incontinence and 5 (8.3%) had mild stress incontinence requiring no treatment. Moderate stress incontinence responded to imipramine in 1 case and collagen injection in 1. Of the patients who were potent preoperatively 31 (52%) remained potent postoperatively. Of the 29 (48%) patients who were impotent preoperatively and immediately postoperatively 9 regained potency at 1 year. However, at 1 year, the quality of erections of the 40 potent men was normal in only 22 (37%) and fair to poor in 18 (30%). The 1-stage delayed bulboprostatic anastomotic urethroplasty has a good long-term result with little morbidity for treatment of posterior urethral ruptures in men.

Posterior urethral disruption secondary to a penetrating gluteal injury

We report a case of a complete posterior urethral injury secondary to a penetrating gluteal injury. Posterior urethral injury usually occurs in male patients with pelvic trauma. The reported incidence of urethral injury with pelvic fracture ranges from 1.6% to 25% (mean 10%), with 66% of them being complete posterior urethral ruptures. Causes of posterior urethral disruptions include blunt trauma, such as occur in road traffic accidents or falls from heights, and high velocity penetrating and crush injuries. Penetrating gluteal injuries that cause posterior urethral damage are extremely rare. This report presents the first case of a complete urethral injury due to a gluteal stab wound. Furthermore, this case demonstrates that any sign of injury to the lower urinary tract, regardless of the cause or weapon implicated, warrants an immediate evaluation.

Rare traumatic aorto-iliac dissection injury in a child with pelvic fracture and urethral rupture: A case report

This is a case report of polytrauma in a 4-year-old boy who sustained a rare aorto-iliac dissection injury along with pelvic fracture and rupture of posterior urethra. This child was initially treated for the rupture of posterior urethra and extravasation of urine with suprapubic cystostomy and drainage. Lower limb ischemia developed later. Exploration showed aorto-iliac dissection injury for which aorto-iliac replacement grafting was carried out. Subsequently delayed repair of posterior urethral rupture by transpubic urethroplasty was carried out.

The Value of Immediate or Early Catheterization of the Traumatized Posterior Urethra

A total of 16 patients with posterior urethral ruptures was treated with the aim of reestablishing urethral continuity immediately or early after injury. Followup ranged from 13 to 83 months (average 27), In all patients an emergency retrograde urethrogram demonstrated extravasation from the posterior urethra. Of the patients 13 were treated with a urethral catheter either immediately or within 1 to 5 weeks after injury. Three patients were treated with a suprapubic catheter alone after unsuccessful attempts at reestablishing urethral continuity and all 3 subsequently required urethroplasty for an obliterative stricture. These 3 patients were also impotent after injury. Of the 13 patients treated with a urethral catheter 8 had the catheter inserted either retrograde (2) in the emergency room or antegrade (6) in the operating room just after the injury, and in 5 the catheter was inserted transurethrally at cystoscopy within a mean of 3 weeks after injury. A total of 7 patients (54%) treated with urethral catheterization had a stricture during followup: 4 responded well to internal urethrotomy and 3 required simple dilation. Of 12 patients 5 (42%) became impotent after injury, while 1 was impotent before injury. No patient became incontinent. We conclude that careful urethral catheter realignment either immediately or within 5 weeks after injury is safe and obviates total urethral closure. Impotence may result from the severity of the injury and not from management with catheterization.

Injury to the posterior urethra: management in children

Our experience with the management of ten children with posterior urethral rupture in the early phase is presented. In seven children (six boys and one girl) in whom a complete rupture had occurred, a suprapubic approach was used and a Foley catheter was passed as a splint after end-to-end primary anastomisis of the torn urethra. In three cases rupture was partial; one was iatrogenic and the others were traumatic. The former was managed by a perineal incision with urethral reconstruction and a cystostomy for urinary diversion. In one traumatic partial tear, simple catheterization through the external meatus was sufficient for perfect healing, while in the second after unsuccessful catheterization, a cystostomy for 2 weeks led to a satisfactory outcome. Three of the seven children with complete rupture developed strictures, which required one or more sounds; one of them also underwent two internal (visual) urethrotomies. All currently have stable stricture formation. One other boy with strictures, who is now 16 years of age, periodically needs bougienage and is completely impotent with probably diminished libido. Nine children now have normal micturition and in six boys erections have been established. Two have begun to ejaculate, but the rest are still too young for definite conclusions. We believe that for a completely disrupted urethra primary end-to-end anastomosis with a few approximating sutures over a Foley catheter placed as a splint is feasible in children and should be attempted as the procedure of choice.

Primary Realignment of Posterior Urethral Ruptures in Children

Primary realignment was used in the treatment of 12 children with complete rupture of the posterior urethra; 10 developed strictures but 7 of these responded to dilation. Problems of continence were encountered only in patients who developed strictures. Since primary realignment results in dilatable strictures in most patients, it is suggested that this should be the treatment of choice in children.

Diagnostic Studies in Bladder Rupture: Indications and Techniques

After external trauma, the patient with bladder injury usually complains of lower abdominal pain and tenderness, and macroscopic or microscopic hematuria is usually present. Simultaneous bladder and posterior urethral rupture can occur in male patients, and the diagnosis of both ruptures is rarely made preoperatively. A delayed presentation with an acute abdomen, absence of voiding, and elevated blood urea nitrogen is sometimes seen in a patient injured during a prolonged alcoholic state or domestic beating, after which the patient is reluctant to seek medical attention, or with a physician misdiagnosis. In patients with pelvic fractures, the incidence of bladder rupture is 6 to 10 per cent. A retrograde cystogram with bladder filling of 400 ml of radiopaque dye followed by a washout film will diagnose intraperitoneal and extraperitoneal ruptures of the bladder. False-negative cystograms occur with penetrating injuries of the bladder when only 250 ml or less of contrast medium is used to fill the bladder.

Management of posterior urethral rupture: a personal view.

The management of urethral injury continues to be controversial and no one policy has received universal acceptance. This review describes the current three-step approach which we use for the investigation and management of this serious injury. This approach has evolved during the management of a large number of these injuries over the past 22 years. It is relatively simple and can be expected to give a high success and low complication rate. We believe that many of the complications encountered following the management of this injury are avoidable.

Simultaneous Bladder and Prostatomembranous Urethral Rupture from External Trauma

Simultaneous bladder and prostatomembranous (posterior) urethral ruptures from external trauma occur in 10 to 29 per cent of male patients with traumatic rupture of the posterior urethra. The records of 47 male patients with traumatic rupture of the posterior urethra were evaluated. A total of 8 patients (17 per cent) had simultaneous rupture of the bladder (4 extraperitoneal, 3 intraperitoneal and 1 both) and posterior urethra (5 complete and 3 partial ruptures). A fractured pelvis was present in all 8 patients, with an average of 3.1 associated injuries per patient. Both ruptures were diagnosed preoperatively in only 1 patient. In male patients with multiple injuries, including a fractured pelvis and rupture of the posterior urethra, a concomitant rupture of the bladder must be suspected and sought at surgical exploration.

Injury to the Male Posterior Urethra in Fractured Pelvis: A New Classification

The present criteria to diagnose a ruptured posterior urethra in cases of a fractured pelvis do not provide accurate information on the degree and site of the urethral injury. A method of retrograde urethrography in such patients is described and the results obtained in 15 cases are reported. On the basis of these results a new classification of membranous urethral rupture in cases of fractured pelvis is proposed: type 1 — the prostate or urogenital diaphragm is dislocated but the membranous urethra is merely stretched and not severed, type 2 — the membranous urethra is ruptured above the urogenital diaphragm at the apex of the prostate and type 3 — the membranous urethra is ruptured above and below the urogenital diaphragm. The clinical significance of these lesions is discussed and a plea is made for the more widespread use of retrograde urethrography in patients with a suspected posterior urethral rupture.

A pull-through operation for the treatment of lesions of the posterior and bulbar urethra.

Authors describe a pull-through operation for treatment of lesion of the posterior and bulbar urethra. Membranous and bulbomembranous stricture, recent rupture of posterior urethra and rectourethral fistula were approched by this surgical procedure.