35. Injury to the urethra. Flashcards
what is the length of the average male urethra
males is 22-25cm
anatomy of male urethra
three Classifications of traumas to the urethra
- Open - very rare. e.g. gun shot, stab wounds
- Closed
- Blunt blow over the perineum (beneath skin of perineum is the bulb of urethra which can cause closed trauma to the urethra).
- Iatrogenic, from harsh retrograde instrumentation such as harsh catheterisation, harsh dilation of urethra, urethrocystoscopy. - Combined
what is the most vulnerable part of the male urethra to trauma
traumas to both segments of the urethra ( anterior and posterior) can occur, but the most vulnerable part of male urethra is membranous urethra.
urethra trauma according to the thichness of the urethral wall
- Complete rupture of urethra 2. Incomplete rupture of urethra
urethral trauma according to the anatomical location
- Extra pelvic - rupture of anterior urethra,
- typical is superficial extravasation of blood and urine which = hematoma.
- Hematoma may spread to:
- Penis, protected by buck’s fascia,
- Scrotum,protected by tunica dartos,
- Perineum, protected by Colley’s fascia,
- Lower abdomen, protected by scarpa’s fascia.
- Hematoma may spread to:
-
Intra pelvic - means rupture of the posterior(prostatic & membranous) urethra,
* typical is deep?extravasation it means the hematoma spreads to pelvic space** and **retroperitoneum.
• NB** what is a a very good example of pus focus in the true pelvis
- extraperitoneal rupture of the urinary bladder -> perivesicular cyst -> perivesicular abscess
- intrapelvic urethral rupture
- Pathollogicsl forms of acute P.N
fBlood discharge from the urethra - medical term i
urethrorrhagia,
it is not connected with the act of urination, means trauma to urethra
how is trauma to the urethra treated
what does it depend on
when is catherisation not done immediatley
which type of catheter is used for incomplete rupture
mc complication post urethral surgery
If there is bloody discharge from urethra (trauma to urethra),
- do not to perform catheterisation before performing a retrograde urethrogram =>shows: 1.continuity of the urethra, 2.level and type of injury.
- Do this first before catheterisation.
Incomplete urethral rupture may be treated
by Foley catheter for 14-21 days.
Complete urethral rupture with dislodgement treatment options
- suprapubic drainage of urethra and immediate urethral repair.
- suprapubic drainage of urethra and delayed urethral repair.
- • Most common complication after urethral surgery is stricture of urethra.
Complete urethral rupture with dislodgement treatment options
- suprapubic drainage of urethra and immediate urethral repair.
- suprapubic drainage of urethra and delayed urethral repair. • Most common complication after urethral surgery is stricture of urethra.
Incomplete urethral rupture may be treated how?
by Foley catheter for 14-21 days.
Most common complication after urethral surgery is
stricture of urethra.
2 types of penile injuries
- Amputation rare but can happen, e.g. machinery accident
- Avulsion of the penile skin Is equal to avulsion of skin of head - SCALP
3 most common causes of penile surgery
- phimosis
- self- injection o foreign bodies or to enlarge penis
- Animal bites (not always just dogs)
- Penile fracture
what is penile fracture?
what causes it?
what is the strongly reccomended treatment?
how does it look and why?
unpleasant acute condition where emergent surgical operation is strongly recommended.
MC cause: sexual positions; like a horse riding position.
sx:
- Rupture of tunica abignea and severe bleeding.
- Leads to swollen and red penis, which looks like an aubergine.
