1.5 Lesions of the urethra and the genital organs, their early and late consequences Flashcards
Etiology of Urethral lesions?
Traumas
Etiology of urethral injuries in females?
traiumas
very rare
associated with gynecological and urological operations
Etiology of urethral injuries in males?
posterior urethral trauma
Anterior urethral trauma:
what is Anterior urethral trauma?
- solitary
- could be iatrogenic: by instrumentation (cystoscopies, catheters, dilators)
- could be Non-iatrogenic: straddle injures as a
result of a direct kick to the perineum or a fall onto a bicycle crossbar or a fence.
what parts anterior urethral injuries involve?
- Involves the bulbar part of the urethra
- A smaller portion of non-iatrogenic trauma involved direct penetrating injuries to the penis
what is The primary morbidity of straddle injury?
urethral stricture
what is posterior urethral injuries?
- Similar to extraperitoneal rupture of the bladder
- associated with fractures and gross disruption of the pelvis
- can be seen in conjunction with multisystem trauma
symptoms of urethral injuries?
- bleeding from the urethral meatus
- inability to urinate,
- palpable full bladder
- “butterfly” perineal hematoma or “high-riding” prostate by physical examination are specific
- Vulvar edema and blood at the vaginal orifice (characteristic for posterior urethral injury in female due to pelvic fracture)
Diagnosis of urethral injuries?
- During physical examination, blood at the urethral meatus
- Impalpable prostate
- Urethrography with water-soluble contrast medium
- Urethroscopy
first line treatment of urethral injuries ?
Minor injuries are treated by urethral catherization for a week or longer
alternative treatment as 2nd line therapy for urethral injuries?
a suprapubic catheter can be inserted, and the patient should be transferred to urology
(until the conditions are more favorable for repair)
treatment of anterior urethral injury?
primary repair is the most favorable.
treatment of posterior urethral injury?
- Conservative approach includes inserting a
suprapubic catheter and wait for better conditions. - An aggressive approach with primary anastomosis is used upon complete posterior urethral rupture.
Penile trauma etiology?
- infrequent
- most commonly fracture caused by excessive bending force during sexual intercourse when the penis is thrust against the partner perineum or pubic symphysis.
- Most ruptures occur distal to the suspensory ligament
Penile trauma symps?
- Cracking or popping sound as the tunica albuginea tears
- pain
- rapid detumescence of the shaf
- discoloration of the shaft
- swelling of the shaft
o The swollen penis often deviates to one side opposite to the tunica tear due to hematoma and mass effect