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
types of urethral injuries in males?
posterior urethral trauma
Anterior urethral trauma:
what is Anterior urethral trauma?
what’s are the causes
- 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.
what is iatrogenic urethral trauma?
secondary to endoscopic trauma and instrumentation; most common cause of urethral stricture.
what parts does 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
straddle injury = It can result from straddling a hard object. Or it can be caused by accidents, such as falling onto a bicycle crossbar
what is posterior urethral injuries?
- 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
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)
Location of urine leak/blood accumulation in anterior urethral injury?
- Blood: accumulates in scrotum
- Urine: escapes into perineal space If Buck fascia (deep fascia) is torn
which part of the urethra affected in ant. urethral injury vs post. urethral injury
ant: Bulbar (spongy) urethra
posterior: membranous urethra
mechanism of fracture in ant. urethral injury?
Perineal straddle injury
clinical presentation of ant. urethral fracture?
Blood at urethral meatus and scrotal
hematoma
Location or urine leak/blood accumulation in postt. urethral injury?
- Urine leaks into retropubic space
mechanism of fracture in post. urethral injury?
Pelvic fracture
clinical presentation of post. urethral fracture?
- Blood at urethral meatus
- high-riding prostate
Diagnosis of urethral injuries?
- During physical examination, blood at the urethral meatus
- Impalpable prostate
- retrograde Urethrography with water-soluble contrast medium
- Urethroscopy
first line treatment of urethral injuries ?
- conservative or surgical
Trans-urethral catheter is contraindicated and insertion can worsen any existing injury
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?
penile fracture
- 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
Penile trauma symps?
- 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
Penile trauma diagnosis
?
- 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
penile trauma treatment?
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
penile trauma differential diagnosis?
Peyronie disease: abnormal curvature of the penis due to fibrous plaques within tunica albuginea
treatment of penetrating penile injury?
-due to animal and human bites
- immediate exploration
- irrigation
- if necessary, excision
- Broad spectrum abx, tetanus and rabies prophylaxis
Scrotal trauma etiology?
- 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.
symps of scrotal traumas?
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
scrotal traumas diagnosis?
- Physical examination
- US: assess integrity of the tunica albuginea and blood supply
treatment of scrotal trauma?
Surgical exploration as early as possible
Scrotal skin injury or genital skin loss etiology?
- necrotizing facsitis (Fournier´s gangrene) if life-threatening
- Polymicrobial infection
- Predisposing: Immune suppression, urinary or fecal alteration, poor hygiene
Scrotal skin injury or genital skin loss treatment?
Multistep:
1. Debridement
2. drainage
3. necrectomy
4. Microbiological testing,
5. broad spectrum antibiotics
