Urethral Tear Research Articles

Rupture of bladder and urethra

Cases of bladder rupture are increasing with the increase of automobile accidents. The usual cause of ruptured bladder is external traumatism to an overfilled bladder, not uncommonly seen in alcoholics. An increasing proportion is associated with fractured pelvis. Occasionally the rupture is secondary to medical manipulations. Intraperitoneal ruptures are more frequent than extraperitoneal ones. Symptoms are shock, abdominal pain and tenderness with marked desire but inability to void. Diagnosis is best made by intravenous pyelography and cystograms showing the diffused dye outside the bladder. This procedure lessens the danger of infection. Rupture of the bladder is a major abdominal catastrophe and requires immediate surgical intervention. Closure of the tear with wide drainage and aspiration is recommended. Complications are shock, hemorrhage and infection. Mortality has been steadily declining, from 78 per cent up to 1907, to 30 per cent in the tabulation of the cases at the Squier Clinic. This percentage might be still lower if the bladder ruptures could be isolated from the high percentage of general injuries with which they are associated. The urethra may be ruptured either from within or without. Rupture from without is the more usual and is generally due to a fall on the perineum. It frequently occurs with fracture of the pelvis. Symptoms are those of pain, hemorrhage and urinary extravasation. Drainage of the extravasated area followed by repair of the urethral tear gives the best results. Use of an indwelling catheter increases the danger of infection. All cases require long after-treatment with sounds to dilate the subsequent stricture. Impotence frequently occurs following this injury.

TRAUMATIC RUPTURE OF THE FIXED PORTION OF THE MALE URETHRA

Traumatic rupture of the fixed portion of the male urethra is a most serious injury, both in its immediate aspect and remote consequences: immediately serious, because of leakage of urine following the several classical paths of extravasation, with subsequent decomposition, or on account of complicating lesions of osseous or soft tissues; remotely so, owing to formation of traumatic stricture, with its attendant urinary stagnation and infection of the entire urinary tract. The force causing a rupture of the urethra acts in one of two ways—in a direct manner, the patient falling astride an object, or indirectly, the pelvic bones being crushed together, the force usually acting in the coronal plane of the body. Produced in a direct manner, the urethral tear may be in a part anterior, within, or posterior to the layers of the triangular ligament, usually without complicating factors. Indirectly produced by crushing force, the tear in the