Urethra

Question 1

Anatomy of Urethra (Male)
Urethral Epithelium

Answer 1

Anterior
Meatus, Penile, Bulbar
Posterior
Membranous, Prostatic, BN
Sphincter Complex

Epithelium
- Meatus + Distal Proximal - Squamous, up to membranous - Pseudostratified Columnar, Prostatic - Transitional

Question 2

Embryology of male urethra

Answer 2

Derived from Endoderm
- Urogenital Sinus from Cloaca
- Urorectal Septum growht at 4 weeks
- Spongy Urethra formed by 7 weeks

Question 3

Urethral Injury - Classification?

Answer 3

Goldman
I - Stretched due to puboprostatic ligament rupture
II - Superior to UG diaphragm - Contrast in pelvis
III - Superior and through UG diaphargm - contrast in pelvis/perineum
IV - Post urethra through BN
V - Isolated anterior urethra injury involving Bulbar urethra

Question 4

Aetiology of Post Urethral Injury

Answer 4

Blunt Trama Ax with Pelvic Fracture
- 20% of PF have PU Injury
- 80% of PU injury due to PF
- 50% Blood at meatus
- Puboprostatic Injury pull prostate away causing disruption of membranous urethra

Also associated with RALP, Radiotherapy, HIFU, Cryo, TURP

Question 5

Immediate management of suspected UI

Answer 5

Stabilise
Examine - abdomen/bladder/bladder scan/Penis/Perineum/PR (High Riding Prostate)
Attempt 16 Ch Catheter 1 time -> RGU (AP +/- Oblique -> 20 ml 50% IV contrast through 12 Ch Catheter with 1ml in balloon) ->Perform
If UC CAN be inserted -> Cystogram (300ml 50% contrast Clamped and drainage X Ray (AP +LAT)
IF RGU shows extravasation -> SPC (Selldinger or Open if going for laparotomy/Pelvic Fixation)

Question 6

When to perform primary repair of urethral injury

Answer 6

Anorectal Injury
BN Tear
Pernieal Degloving

Question 7

Bladder Injury Management:
IP Rupture
BN Rupture
EP Rupture

Answer 7

IP - Repair
BN - Repair
EP - Catheter. May need repair

Question 8

Ant Urethral Injury
Aetiology

Answer 8

Fall Astride, Blunt perineum injury, Penile Fracture (20% ax AUI), catheters/instrumentation),

Question 9

i) Mx of AUI
ii) In Penile Fracture

Answer 9

Attempt catheterisation ->
Fails - > RGU + SPC

ii) In penile fracture - Flexi guided placement

Question 10

When to perform primary AUI repair

Answer 10

Penile Fracture
Penetrating Injury
De-Gloving Injury

Question 11

FU for:
i) Partial AUI
ii) Complete AUI

Answer 11

i)
UC:
**3 weeks ** TWOC , MSU, FR
12 weeks FR/Urethrogram/Flexi
6 months + **12 Months ** - FR

ii)
SPC:
Day 0 MSU/RGU/Flexi
3 Months Surgical Repair

Question 12

Stricture Repair:
Bulbar
Penile

Answer 12

Bulbar:
Excision and End to End Anastamosis
Single Stage with BMG

Penile:
Two Stage Urethroplasty with BMG
Single stage urethroplasty with BMG