Urethral Rupture Research Articles (Page 1)

ObjectivesThe aim of this study was to determine if there were any characteristic features of urethral ruptures (URs) on plain radiographs of cats.MethodsA retrospective, multicentre, case-control study was conducted. Radiographs including the perineum of 22 cats with UR and 70 cats without UR were blindly assessed by two reviewers, scrutinising for features including a perineal bulge, heterogeneous perineal tissue and visibility of the urinary bladder.ResultsA significant association was identified between URs and a perineal bulge (P ⩽0.003), resulting in a sensitivity of 95.5% and a specificity in the range of 38.6–47.1%, and between the presence of URs and a larger perineal bulge size (P <0.001). URs secondary to traumatic accidents were associated with a larger perineal bulge than those secondary to iatrogenic rupture. Cats with URs were more likely to have heterogeneous perineal tissue (P <0.001). There was a significant association between pelvic fractures and a perineal bulge (P ⩽0.001), but not between pelvic fractures and URs (P = 0.783). Binary logistic regression revealed associations between the reviewers’ suspicion for a UR and the reviewers’ recommendation for a lower urinary tract contrast study (LUTS) and a confirmed UR (P <0.001). There was no significant association between an invisible urinary bladder and the presence of a UR (P ⩾0.243).Conclusions and relevanceIdentification of a perineal bulge or heterogeneous perineal tissue in a cat may raise suspicion for a UR, especially in the absence of musculoskeletal injury, which is crucial in reducing time to diagnosis and, therefore, treatment. However, because of the low specificity, correlation with the clinical findings and confirmation or exclusion via a LUTS remains necessary. Visibility of a urinary bladder does not exclude UR.

Open pelvic fractures represent severe traumatic injuries with mortality rates approaching 50%. Complex cases involving multiple organ injuries and massive hemorrhage pose significant challenges in clinical management. Despite advances in trauma care, comprehensive documentation of successful management strategies for severe open pelvic fractures with multiple complications remains limited. A 36-year-old female presented with an open pelvic fracture following a motor vehicle collision, complicated by hemorrhagic shock (blood pressure 66/45 mm Hg), multiple organ injuries including bladder rupture and rectal damage, and an 18-cm open wound from the right groin to the anus with active bleeding. Young and Burgess anterior-posterior compression III type pelvic fracture with vertical shear mechanism, bilateral internal iliac artery injuries, complete bladder and urethral rupture, and extensive perineal-rectal injuries. The patient underwent multiple staged interventions including emergency arterial embolization and stenting, external pelvic fixation, bladder repair, sigmoid colostomy, serial wound debridements, negative pressure wound therapy, and final reconstruction with muscle flap transposition and skin grafting. Treatment required 148 days of hospitalization, including 22 days in intensive care unit. The patient achieved successful recovery with healed fractures and wounds, though requiring permanent colostomy and cystostomy. Rehabilitation enabled functional recovery and return to daily activities. Successful management of complex open pelvic fractures requires prompt hemorrhage control through interventional procedures, implementation of damage control principles with staged surgical approaches, close multidisciplinary collaboration, and comprehensive wound care and infection management. This strategy can significantly improve survival outcomes in severe cases.

Urethral injuries associated with pelvic fractures in female patients are a rare condition. The diagnosis and management of traumatic injury to the female urethra are not well-understood, as the literature on the subject is very limited. Hereby, the authors present a case of a 29-year-old female patient who presented with continuous incontinence. The patient had a history of trauma while riding a bicycle 18 years ago, resulting in a pelvic fracture, bladder rupture, and urethral rupture. She was managed with fracture fixation, bladder repair, and Suprapubic Catheter (SPC) insertion. Urethral repair was performed after six months, but the patient remained incontinent. Upon presentation to our hospital, the patient was diagnosed with vaginal stenosis and a large urethrovaginal fistula. She was managed with vaginoplasty followed by urethrovaginal fistula repair using gracilis muscle interposition. This procedure failed, resulting in the recurrence of the Urethrovaginal Fistula (UVF) and ongoing incontinence. The patient was re-operated, and fistula repair was accomplished using a local vaginal flap. This case highlights the complex nature of urethral injury in females, the challenges posed by delayed complications, and the necessity for multiple procedures.

In practice, urinary tract disorders are increasingly reported in dromedary camels, particularly in regions where environmental stress and limited resources prevail. Our primary goal in writing this review was to provide a simple, accessible, and practical data tailored for veterinary clinicians working with dromedary camels in remote and resource-limited environments. These veterinarians often operate under harsh conditions such as pastoral regions of North Africa, the Middle East, and parts of South Asia, with very basic tools and limited access to advanced diagnostic equipment. Therefore, we intentionally structured this manuscript to be practical and user-friendly in such settings, emphasizing clinical relevance and practicality over exhaustive academic depth. The review is structured to highlight the main urinary disorders affecting dromedary camels, with a focus on their incidence, clinical presentation, and sonographic characteristics. While not exhaustive in academic detail, this review maintains scientific accuracy with a focus on practical application. The first section discusses the incidence and trends of various urinary tract disorders observed in dromedary camels. The second section provides an overview of the ultrasonographic anatomy of the urinary system in healthy camels. The third and main section focuses on the ultrasonographic findings associated with urinary tract disorders in affected camels that contains illustrative images of published case reports as well as clinical studies. This section is further divided into seven subsections: (1) pyelonephritis and renal abscesses, (2) urinary tract calculi, (3) urine retention, dribbling, and anuria, (4) urinary bladder rupture, (5) urethral rupture, (6) cystitis, and (7) urinary neoplasia. A thorough understanding of the pathophysiology of urinary tract diseases in dromedary camels is essential for developing effective treatment and control strategies considering normal variation or age-related differences. If appropriate, the review discusses also treatment options or preventive measures based on sonographic findings. By presenting recent research findings, this review aims to raise awareness and guide future strategies for the diagnosis and management of urinary tract diseases in dromedary camels, ultimately contributing to improved health outcomes in both domestic and wild populations.

ObjectivesTo describe the successful conservative management of urinary tract ruptures in dogs and cats.Materials and MethodsMedical records of a hospital between 2003 and 2024 were reviewed to identify dogs and cats with urinary tract rupture. Cases were included if they were successfully managed conservatively (including only procedures that did not directly address the site of rupture). Data recorded included signalment, cause and location of rupture, method and duration of urinary diversion, outcome and complications.ResultsFifty‐two cases (40 cats and 12 dogs) were included. The most common causes of rupture were trauma associated with urethral obstruction and catheterisation (18), cystocentesis (17) and external trauma (8). The most common sites of rupture were the urethra (20 cats and five dogs) and urinary bladder (15 cats and four dogs). Bladder ruptures were most commonly managed with urethral catheters and/or peritoneal drains, while urethral ruptures were most commonly managed with urethral catheters and/or cystostomy tubes. The median (range) time to resolution of urine leakage documented on imaging was 3 (1 to 6) days for bladder ruptures and 6.5 (3 to 28) days for urethral ruptures. Radiographic evidence of urethral narrowing was documented in 11/25 cases with urethral tears at a median (range) of 12 (4 to 28) days post‐rupture. Urine culture was performed in 22/52 cases with urinary tract ruptures and was positive in 14 cases.Clinical SignificanceConservative management can be considered in both iatrogenic and traumatic urinary tract ruptures. The risk of urethral strictures and urinary tract infections should be considered when electing for conservative management of urinary tract ruptures.

Early Surgical Repair in a Patient with Post-Traumatic Complete Posterior Urethral Rupture Associated with both Vaginal and Rectal Injury

Introduction: Penile fracture is a rare urological emergency characterized by the rupture of the tunica albuginea, commonly associated with trauma to one or both corpora cavernosa. In severe cases, additional damage to the corpus spongiosum and urethra can occur. Immediate surgical intervention is crucial for optimal recovery, reducing complications such as erectile dysfunction and urethral strictures. Objective: To present a rare case of penile fracture involving both corpora cavernosa and complete urethral rupture, managed surgically. A brief literature review is also included. Case Report: A 33-year-old male presented to the emergency department after hearing a snapping sound during sexual intercourse, followed by detumescence, urethrorrhagia, and penile pain. Initial misdiagnosis led to a delayed referral, at which point imaging confirmed bilateral fractures of the corpora cavernosa and complete urethral rupture. Surgical exploration revealed complete penile urethral avulsion. The patient underwent successful primary urethral anastomosis and repair of the tunica albuginea, followed by an uneventful postoperative recovery. At follow-up, the patient reported no urinary issues, preserved erectile function, and normal sexual activity. Discussion: The diagnosis of penile fracture is primarily clinical, often associated with sudden detumescence, penile deviation, and urethral bleeding. Imaging, such as ultrasonography or MRI, assists in confirming the diagnosis and identifying associated injuries. Immediate surgical repair is the treatment of choice, offering better functional outcomes compared to conservative management. In this case, early surgical intervention resulted in complete recovery without complications. Conclusion: Penile fracture with bilateral corporal injury and urethral rupture is a rare but challenging condition. Prompt diagnosis and early surgical repair are essential for favorable outcomes, as demonstrated in this case.

Urethral Trauma is a discontinuity of urethra which caused by external stress (pelvic fracture or straddle injury) or internal stress (catheter placement, urological procedures). There are several suitable techniques, including immediate exploration or urine diversion. The treatment used depend on the cause of the rupture, rupture length, as well as anatomical position of the rupture. A 46-year-old male suddenly presented with swollen penile and testicle after 1 day of hospitalization. One day before, patient suffers in high-speed motorcycle accident and sustains blunt trauma to the perineal area, hitting the handle bar of the motorcycle and brought to the emergency department. There was a palpable bladder distension during physical exam, with penis and scrotum enlargement. Laboratory findings show elevated WBC and elevated creatinine level. Urinalization test was within normal limit. Partial laceration found during urethroscopy approximately &lt;1cm in size. Scrotal drainage and exploration are conducted due to scrotum being swollen progressively. There is uncertainty regarding these symptoms to be interpreted as a urethral injury because some of the classical symptoms are missing, although patient showed with palpable bladder distension. Due to the swollen penis and scrotum which are enlarged progressively, urethroscopy and scrotal exploration was performed. Small laceration on the bulbar area of the urethra is found, indicating anterior urethral rupture, the laceration is treated conservatively with the placement of transurethral catheter. Scrotal exploration then performed which pus and extravasation of urine is found within the scrotum. The precision on determining anterior urethral rupture as a diagnosis decides the management, prognosis and complication rate of anterior urethral rupture. Although, the initial urethral trauma management remains disputed, a bulbous urethral rupture with a complication of extravasation of urine into the penis and scrotum can be treated effectively with urine diversion and scrotal exploration Urethral Rupture

BACKGROUND: Combined pelvic trauma in men in 10%–24% of cases is accompanied by damage to the posterior urethra, and no consensus on the treatment tactics has been established for such patients. AIM: This study aimed to evaluate the results of treatment of patients with closed injury of the posterior urethra and traumatic shock. MATERIALS AND METHODS: A retrospective analysis of the results of treatment of 46 patients with closed injury of the posterior urethra caused by a fracture of the pelvic bones and traumatic shock was performed. The average age of patients was 42.1 ± 9.9 years. The severity of urethral injuries was assessed according to the American Association for the Surgery of Trauma (AAST) classification. RESULTS: The choice of treatment techniques depended on the degree of damage to the urethra and severity of traumatic shock. Upon hospital admission, 15 (32.6%) patients were diagnosed with grade I, 21 (45.6%) with grade II, and 10 (21.7%) with grade III traumatic shock. In grade I–II traumatic shock patients with incomplete urethral rupture, a urethral catheter was inserted, followed by conservative therapy. If a catheter insertion was possible, a retropubic revision of the urethra was performed. Patients with grade III–V urethral injury according to AAST and grade I–II traumatic shock underwent primary or delayed urethroplasty, such as urethral suturing and urethra-urethral anastomosis. Patients with grade III traumatic shock had a urethral catheter or cystostomy. In the long-term, 6 of 17 (36.9%) patients who underwent primary or delayed urethroplasty had short-term (up to 5 mm) urethral strictures, for which optical urethrotomy was performed. All patients with complete urethral avulsion who did not undergo early urethroplasty developed 10–20 mm strictures, requiring reconstructive surgery. CONCLUSIONS: The choice of treatment techniques for patients with concomitant damage to the posterior urethra depends on the degree of damage to the urethra and severity of traumatic shock. The scope of treatment in the acute period may include urethral or suprapubic drainage of the bladder or reconstructive surgery.

This retrospective study evaluated the safety and efficacy of fluoroscopy-guided urethral catheterization in patients who failed blind or cystoscopy-assisted urethral catheterization. We utilized our institutional database between January 2011 and March 2023, and patients with failed blind or cystoscopy-assisted urethral catheterization and subsequent fluoroscopy-guided urethral catheterization were included. A 5-Fr catheter was inserted into the urethral orifice, and the retrograde urethrography (RGU) was acquired. Subsequently, the operator attempted to pass a hydrophilic guidewire to the urethra. If the guidewire and guiding catheter could be successfully passed into the bladder, but the urethral catheter failed pass due to urethral stricture, the operator determined either attempted again with a reduced catheter diameter or performed balloon dilation according to their preference. Finally, an appropriately sized urethral catheter was selected, and an endhole was created using an 18-gauge needle. The catheter was then inserted over the wire to position the tip in the bladder lumen and ballooned to secure it. We reviewed patients’ medical histories, the presence of hematuria, and RGU to determine urethral abnormalities. Procedure-related data were assessed. Study enrolled a total of 179 fluoroscopy-guided urethral catheterizations from 149 patients (all males; mean age, 73.3 ± 13.3 years). A total of 225 urethral strictures were confirmed in 141 patients, while eight patients had no strictures. Urethral rupture was confirmed in 62 patients, and hematuria occurred in 34 patients after blind or cystoscopy-assisted urethral catheterization failed. Technical and clinical success rates were 100%, and procedure-related complications were observed in four patients (2.2%). The mean time from request to urethral catheter insertion was 129.7 ± 127.8 min. The mean total fluoroscopy time was 3.5 ± 2.5 min and the mean total DAP was 25.4 ± 25.1 Gy cm2. Balloon dilation was performed in 77 patients. Total procedure time was 9.2 ± 7.6 min, and the mean procedure time without balloon dilation was 7.1 ± 5.7 min. Fluoroscopy-guided urethral catheterization is a safe and efficient alternative in patients where blind or cystoscopy-assisted urethral catheterization has failed or when cystoscopy-urethral catheterization cannot be performed.

Background: Urethral stricture in males is a narrowing of the anterior urethra caused by fibrosis and cicatrisation of the urethral mucosa and adjacent spongiosus tissue ("spongiofibrosis"). In the male posterior urethra, there is no spongiosus tissue; therefore, stenosis is the preferred term. Understanding the risk factors of urethral strictures may be amenable to preventive measures resulting in a decrease in disease severity and health care expenditure. Aim: This study aims to summarize and assess the risk factors of urethral stricture through a comprehensive systematic review. Methods: A systematic search strategy was conducted across several electronic reference databases (PubMed, Cochrane Library, Google Scholar) and included articles published between 2013–2023. Duplicate publications, review articles, and incomplete articles were excluded. Results: The databases search identified a total of 16.645 articles (Table 1) and resulted in 16.155 articles after duplicates removed. Of these, 15.955 articles were excluded due to non-original study and titles and abstract not represented the focus of interest; and resulting in 200 articles for screening process. Articles not evaluating the focus of interest and articles in which full-text are not available are excluded, resulting in 15 articles for eligibility criteria. Among them, 10 articles did not give sufficient details about the risk factors of urethral stricture and some did nit differenriate clearly between the risk factors of urethral stricture and recurrence of urethral stricture. Hence, we found 5 appropriate studies included. Conclusion: The risk factors of urethral stricture in this study includes the dose of brachyterapy for prostate cancer patients, lower resection speed of BPH, prolonged operative time, intraoperative urethral mucosa rupture, post-operative continuous infection, the diameter of the instrument, presence of chronic prostatitis in anamnesis, increased volume of the prostate, repeated drainage of the bladder using the urethral catheter, high comorbidity burden, second TURP surgery, history of preoperative catheter insertion, high postoperative WBC, and long postoperative catheterization time.

ABSTRACT&#x0D; Objective: To present a case of urethral injury treated in a male adult. Case(s) Presentation: A 48 year old Asian male patient previously involved in a motor vehicle accident presented to the hospital with a chief complaint of pain and bleeding from the genitalia. On examination, it is revealed bleeding from the urethral meatus, pain in touch, palpable bladder, high riding prostate, and a butterfly-shaped bruising on the perineum. X-ray examination demonstrated soft tissue mass in the right scrotal region. The patient is diagnosed with urethral rupture with urinary retention and then underwent ultrasonography-guided cystostomy and perineal hematoma evacuation. The patient is followed-up 1 month later with a complaint of difficulty in voiding and erectile dysfunction. The patient is then diagnosed with urethral stricture and underwent direct vision urethrotomy. Discussion: Urethral injury is a rare type of injury of genitourinary trauma that may cause long term morbidity such as strictures, incontinence, impotence, and infertility. Urethral injury can be classified into posterior urethral injury which is associated with pelvic fracture and anterior urethral injury which is associated with blunt trauma. The gold standard of radiographic examination in urethral injury is dynamic retrograde urethrography. Prompt diagnosis, staging, and selecting intervention must be done for minimalizing complications. Sequelae may also develop which also affects quality of life. The usage of universal health coverage such as BPJS in In Indonesia can increase the accessibility of medical treatment. Conclusion: Urethral injury is a rare injury that requires prompt and careful management to minimize complications and increase the patient’s quality of life.&#x0D; Keywords: Urethral Injury, urethrotomy, urethral stricture.

ABSTRACT Objective: This case report aims to describe a different approach of PFUI by conservative management that resulted in good outcome. Case(s) Presentation: A 7-year-old girl patient was brought to the emergency department after falling from public transportation diagnosed with suspicious urethral rupture, perineal rupture grade III, vertical-shear type pelvic-ring injury, laceration wound on the right lower leg, abrasion on the medial side left lower leg and urinary retention. The patient underwent percutaneous cystostomy, pelvic bandage, a perineal debridement and repair, a cystography, percutaneous vesicolithotripsy, cystostomy and synechiae incision. One year after the first admission it was planned for urethroplasty due to completely obliterated from antegrade and retrograde panendoscopy. Discussion: 8 months later urethroplasty was aborted because of an open bladder neck, a fistula at the anterior connected to the distal of the bladder neck with size of 3 mm. The patient was performed a silicon cystostomy catheter insertion for 6 weeks. At the time of evaluation, the fistula was closed, it was proven by Qmax uroflowmetry was 18ml/s with average flow: 9.8 ml/s, voiding volume: 90ml, flow time: 9s, voiding time: 9s, hesistance:1.5, and PVR:5.35 cc. Conclusion: In this case, it showed that conservative management could improve PFUI with satisfactory result, proved by good result of uroflowmetry. However, periodic evaluations must be carried out to follow the progress of the disease and the possibility of future complications including sexual function. Keywords: PFUI, girl, urethral rupture

Post-traumatic rupture of the posterior urethra is a serious injury that can compromise the micturition and erectile prognosis of the often-young patient. The management of this lesion is still controversial, leaving the choice between early endoscopic realignment or suprapubic catheterization with deferred urethroplasty. The objective of this study was to report our clinical experience and outcomes with early endoscopic realignment (EER) for patients with pelvic fracture urethral injury. We underwent a retrospective review of patients with pelvic fracture associated urethral injury who underwent EER from 2010 to 2020. Preoperative, perioperative, and postoperative outcome data were collected. Complications for the surgical procedure were analyzed, as well as postoperative stenosis, urinary incontinence and erectile dysfunction. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow-up. Early endoscopic realignment was performed in 26 patients managed for complete post-traumatic posterior urethral rupture. The median age was 26 (16-39) years. The most common mechanism of urethral injury was road traffic accidents in 69.23% of cases. The most common urethral injury was grade 4 in 23patients (88.46%). The median time to endoscopic realignment was 8days (3-18). The median time to postoperative bladder catheterization was 22 (10-32) days. The median follow-up time was 34 (18-54) months. Ten patients developed urethral stricture during follow-up: 7 (26.92%) were treated with one or two internal cold blade urethrotomies, 3 required urethroplasty. There were no urethroplasty failures after a first endoscopic realignment. Two patients reported severe stress urinary incontinence. The median IIEF-5 score at the date of last news was 23 (17-25). Early endoscopic realignment allows some patients to avoid a heavier surgical treatment, and doesn't compromise the realization of a later urethroplasty.

Penile fractures can lead to many functional complications, especially erectile dysfunction (ED). Few studies have evaluated the factors that predict late complications of an immediately repaired penile fracture. To identify the potential predictors of long-term poor functional outcomes following immediate surgical intervention for penile fractures. Sixty-eight consecutive patients with suspected penile fracture between 2003 and 2022 were retrospectively reviewed. Functional outcomes, postoperative complications, and follow-up duration were obtained from the records of follow-up visits. Age at presentation, location and length of the tunical tear, the presence of urethral rupture, and time to surgery were all analyzed as potential risk factors for postoperative functional outcomes. Postoperative erectile function and intercourse satisfaction were measured by the IIEF-5 (the 5-item version of the International Index of Erectile Function). Penile curvature, a palpable nodule, and paresthesia/numbness were detected by physical examination. Uroflowmetry was used to assess urinary flow in patients who underwent urethral repair. Fifty-eight patients were analyzed. The mean ± SD age was 38.1 ± 10.4years; the median follow-up was 79.0 months (range, 13-180); the median time to surgery was 9.8 hours (4-30); and the median tunical tear length was 15.5 mm (4-40). Urethral rupture was observed in 8 patients (13.8%). In univariable analyses, urethral rupture was associated with postoperative complications (P = .034). In addition, age at presentation and tunical tear size were significantly associated with postoperative complications and ED (P < .05). However, in multivariable analyses, only age at presentation significantly predicted postoperative complications and ED (P = .004 and P = .037). Age at presentation is the most important factor determining the prognosis of immediate surgical repair of the penile fracture, which aids in predicting potential complications and discussing them with patients prior to surgical intervention and during the follow-up period. The study's retrospective design is an important limitation. Furthermore, there were no data on an IIEF-5 outcome measuring preoperative erectile function. These results revealed an association between (1) urethral rupture, longer tunical tears, and older age and (2) the development of late complications. The remarkable finding of this study was that age at presentation was the only significant predictor of functional complications based on multivariable analyses. This relationship also remained robust in tests evaluating the covariance of the effects of aging on ED.

The management of post-traumatic rupture of the posterior urethra remains controversial, leaving the choice between early endoscopic realignment (EER) or suprapubic catheterization with deferred urethroplasty. The objective is to compare the results of endoscopic realignment and those of urethroplasty in terms of voiding. We underwent a retrospective study collating all patients managed for post-traumatic complete urethral rupture between 2010 and 2020. These patients were subdivided into two groups: a first one including those who had an endoscopic realignment and a second one including those who had a deferred urethroplasty. We studied the quality of voiding and the complications that occurred in each group. The success of the technique was defined by the resumption of a satisfactory voiding, and the absence of recourse to the urethroplasty in case of endoscopic realignment. Satisfactory voiding was defined by a Qmax ≥ 15mL/s and a post-void residual (PVR) < 150ml by ultrasound. Fifty-eight patients were identified. The mean age was 32 ± 12years. Endoscopic realignment was performed in 26 patients. Satisfactory voiding was reported in 16 patients (61.53%). Recourse to internal urethrotomy after realignment was reported in 7 patients (26.92%). Three failures of endoscopic realignment were reported, necessitating an urethroplasty. Two patients reported urinary incontinence. Urethroplasty was performed in 32 patients. Satisfactory voiding was noted in 22 patients (68.75%). The use of internal urethrotomy after surgery was reported in 5 patients (15.62%). Three patients had treated urinary incontinence. Comparing the two groups, there was no significant difference in postoperative IPSS, flow rate (Qmax), post-void residual urine volume (PVR), satisfactory voiding, and stress urinary incontinence. The voiding outcomes were comparable for both techniques. We conclude that endoscopic realignment can be indicated in first intention, provided certain conditions are met, in order to minimize the morbidity of prolonged suprapubic drainage.

Objective: to highlight the epidemiological, lesional and therapeutic aspects of urinary trauma in the urology department of the Ignace Deen National Hospital in Conakry. Material and methods: this was a retrospective study that took place over a period of 5 years, during which we collected all cases of urinary trauma in the urology department of the Ignace Deen National Hospital in Conakry. The variables studied were socio-demographic, anatomical-clinical and therapeutic. Results: we collected 75 cases of urinary trauma, representing 15.5% of abdomino-pelvic trauma admitted to hospital during the study period. The average age of patients was 29 years old with extremes of 8 and 66 years. Men were the most affected with a gender ratio of 25. Road traffic accidents were the most frequent etiologies. The consultation time was less than 24 hours in 92% of cases. Trauma involved the urethra in 80% of cases, the bladder (10.7%) and the kidney (9.3%). The mechanism of trauma to the urethra was dominated by astride falls on the perineum in 52% of cases. Posterior urethra ruptures were associated with pelvic trauma in 20/25 cases and bladder trauma in 5/8 cases. The treatment was carried out according to the type of lesion. Conclusion: urinary trauma is not uncommon in our practice. They are the prerogative of young men in full activity. They are dominated by urethral ruptures, followed by trauma to the kidney and bladder. Treatment should be as conservative as possible in closed kidney trauma and peritoneal ruptures of the bladder.

The urinary catheters’ mean indwelled duration after PIUR (primary interventional urethral realignment) is 25 days. Only four cases of forgotten urinary catheter were reported in the literature. The objective of this clinical case report is to highlight the unusual finding of a four-years forgotten urinary catheter in a young sexually active 23-year-old man and its management, aspiring future similar endeavors. A 23-year-old man presented to the hospital exhibiting severe supra-pubic pain and inability to urinate for one day. He described undergoing PIUR for a traumatic urethral rupture four years ago. An indwelling urinary catheter was placed subsequently, that he claims being removed by his physician 21 days later. Urinary hesitancy and frequency were reported since then, maintaining normal sexual activity. Based on having a tender vesicular globe, and a disclosed rod inside his penis, he was diagnosed with urinary retention by a foreign body and admitted to the hospital for further investigations. Vesicular decompression by a supra-pubic catheter was performed. A non-contrast pelvic CT scan revealed a calcified elongated structure suspecting an encrusted retained urinary catheter. In the operating room, rigid ureteroscope with the assistance of lithotripsy were proficient in fragmenting only intra-urethral calcifications. Sequentially, an open cystolithotomy evacuated the remaining calcified vesicular balloon. Patient was asymptomatic on subsequent visits denying any urinary symptoms and stating normal sexual activity. Removing such a foreign body, especially when severely encrusted as well as avoiding trauma to the urethra while minimizing patient morbidity remain a clinical confront for the surgeon. Hence, minimally invasive procedures are always preferred. In this case, we had to assist the rigid ureteroscope and the lithotripsy by an open cystolithotomy for the large calcified balloon. Nevertheless, this method has proved to be safe and efficient. Thus, it is suggested to be used in future comparable cases.

Injuries to the birth canal can occur accidentally, such as in an episiotomy. Of 85% of maternity mothers who experienced injuries, 35% experienced perineal rupture, 25% experienced cervical rupture, 22% experienced vaginal injuries, and 3% experienced urethral rupture. This study aimed to determine the effectiveness of snakehead fish extract on the healing of perineal wounds in maternity mothers at the Z Clinic, Tangerang. This study is experimental research with a quasi-experimental research design with a non-equivalent control group design. The sample in this study was maternity mothers. Data in this study were analyzed using Univariate and bivariate analyses (Mann-Whitney test). It was found that the average healing of perineal wounds in the group given snakehead fish extract on day 3 was 9.2, while the average healing of perineal wounds on day 8 was 6.1. Then the average healing of perineal wounds in the group not given snakehead fish extract on day 3 was 9.2, while the average healing of perineal wounds on day 8 was 7.0. There is an effect of snakehead fish extract on the healing of perineal wounds in maternity mothers at the Z clinic, Tangerang with a p-value = 0.001. There is an effect of snakehead fish extract on the healing of perineal wounds in maternity mothers.

Fractured penis is reported as a traumatic rupture of the tunica albuginea by following blunt injury to an upright penis. Though a rare urological emergency due to blunt trauma to a turgid penis. The rupture of the tunica albuginea is often single involving either of the two corpora cavernosa; however concomitant urethral injury is an exceptionally infrequent condition requiring primary urethral anastomosis. Many of the patients are likely to have urethral strictures following surgery. Buccal mucosal graft is repeatedly used for substitution urethroplasty in urethral stricture management; however, its use is not commonly reported for immediate treatment in the background of fractured penis. Herewith is the report of a 33-year-old male with rupture of both corpora cavernosa, as well urethral rupture, after coitus. The urethral injury was repaired using buccal mucosal graft. At follow-up, patient did not encounter erectile or voiding issues. The implementation of this technique would go a long way at ameliorating the occurrence of urethral strictures in these subsets of patients, however there is still room for larger sample-sized prospective studies in the future. Consistent with our index case, surgery for the fractured penis is expedient with a view to conserving urethral and sexual function.