1.5 Lesions of the urethra and the genital organs, their early and late consequences

Question 1

Etiology of Urethral lesions?

Answer 1

Traumas

Question 2

Etiology of urethral injuries in females?

Answer 2

traiumas
very rare
associated with gynecological and urological operations

Question 3

types of urethral injuries in males?

Answer 3

posterior urethral trauma
Anterior urethral trauma:

Question 4

what is Anterior urethral trauma?

what’s are the causes

Answer 4

• 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.

are rarely associated with pelvic fractures but can occur after trauma that involve a direct blow to the perineum.

Question 5

what is iatrogenic urethral trauma?

Answer 5

secondary to endoscopic trauma and instrumentation; most common cause of urethral stricture.

Question 6

what parts does anterior urethral injuries involve?

Answer 6

• Involves the bulbar part of the urethra
• A smaller portion of non-iatrogenic trauma involved direct penetrating injuries to the penis

Question 7

what is The primary morbidity of straddle injury?

Answer 7

urethral stricture

straddle injury = It can result from straddling a hard object. Or it can be caused by accidents, such as falling onto a bicycle crossbar

Question 8

what is posterior urethral injuries?

Answer 8

• most commonly occur as a result of pelvic fractures (trauma).
• Ranges from a contusion injury, to complete disruption of the posterior urethra
• Similar to extraperitoneal rupture of the bladder
• can be seen in conjunction with multisystem trauma

Question 9

symptoms of urethral injuries?

Answer 9

• 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)

Question 10

Location of urine leak/blood accumulation in anterior urethral injury?

Answer 10

• Blood: accumulates in scrotum
• Urine: escapes into perineal space If Buck fascia (deep fascia) is torn

Question 11

which part of the urethra affected in ant. urethral injury vs post. urethral injury

Answer 11

ant: Bulbar (spongy) urethra
posterior: membranous urethra

Question 12

mechanism of fracture in ant. urethral injury?

Answer 12

Perineal straddle injury

Question 13

clinical presentation of ant. urethral fracture?

Answer 13

Blood at urethral meatus and scrotal
hematoma

Question 14

Location or urine leak/blood accumulation in postt. urethral injury?

Answer 14

• Urine leaks into retropubic space

Question 15

mechanism of fracture in post. urethral injury?

Answer 15

Pelvic fracture

Question 16

clinical presentation of post. urethral fracture?

Answer 16

• Blood at urethral meatus
• high-riding prostate

Question 17

Diagnosis of urethral injuries?

Answer 17

• During physical examination, blood at the urethral meatus
• Impalpable prostate
• retrograde Urethrography with water-soluble contrast medium
• Urethroscopy

Question 18

first line treatment of urethral injuries ?

Answer 18

• conservative or surgical

Trans-urethral catheter is contraindicated and insertion can worsen any existing injury

Question 19

alternative treatment as 2nd line therapy for urethral injuries?

Answer 19

a suprapubic catheter can be inserted, and the patient should be transferred to urology
(until the conditions are more favorable for repair)

Question 20

treatment of anterior urethral injury?

Answer 20

primary repair is the most favorable.

Question 21

treatment of posterior urethral injury?

Answer 21

1. Conservative approach includes inserting a
   suprapubic catheter and wait for better conditions.
2. An aggressive approach with primary anastomosis is used upon complete posterior urethral rupture.

Question 22

Penile trauma etiology?
penile fracture

Answer 22

• Extreme angulation of the erect penis during sexual intercourse (rupture of tunica albuginea)
• Tunica tear needs immediate exploration of the penis to evacuate the hematoma and repair the injury
• Most ruptures occur distal to the suspensory ligament

Question 23

Penile trauma symps?

Answer 23

• Cracking or popping sound as the tunica albuginea tears
• pain
• 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

Question 24

Penile trauma diagnosis
?

Answer 24

• History and clinical presentation
  (The classic history is diagnostic, and the tear in the tunica can be palpated in some cases)
• Check for urethral injury
• In uncertain cases: MRI of the penis will differentiate between complete tunica tear and intracavernosal hematoma

Question 25

penile trauma treatment?

Answer 25

Surgical intervention is advised without delay:
- The fracture must be explored and repaired with interrupted absorbable sutures
- Start wide spectrum antibiotics and sexual abstinence for 4-6 weeks

Question 26

penile trauma differential diagnosis?

Answer 26

Peyronie disease: abnormal curvature of the penis due to fibrous plaques within tunica albuginea

Question 27

treatment of penetrating penile injury?

Answer 27

-due to animal and human bites

• immediate exploration
• irrigation
• if necessary, excision
• Broad spectrum abx, tetanus and rabies prophylaxis

Question 28

Scrotal trauma etiology?

Answer 28

• Majority of testicular traumas: due to blunt injury (sport related, assaults, motor vehicle accidents)
• minority: penetrating injuries (gunshots,
  explosions)
• can result in rupture of the tunica albuginea.

Question 29

symps of scrotal traumas?

Answer 29

o severe scrotal pain and nausea

o Scrotal hemorrhage and hematocele present in almost all cases (swelling)

o Consider rupture of testis in all cases with scrotal trauma

Question 30

scrotal traumas diagnosis?

Answer 30

• Physical examination
• US: assess integrity of the tunica albuginea and blood supply

Question 31

treatment of scrotal trauma?

Answer 31

Surgical exploration as early as possible

Question 32

Scrotal skin injury or genital skin loss etiology?

Answer 32

• necrotizing facsitis (Fournier´s gangrene) if life-threatening
• Polymicrobial infection
• Predisposing: Immune suppression, urinary or fecal alteration, poor hygiene

Question 33

Scrotal skin injury or genital skin loss treatment?

Answer 33

Multistep:
1. Debridement
2. drainage
3. necrectomy
4. Microbiological testing,
5. broad spectrum antibiotics