A Case Report of Urethral Injury

Abstract

Mrs. S., a 23-year-old, married for 2 years presented to us with continuous leakage of urine for the last three months. The problem arose when she delivered a dead full term foetus at home by a dai in March 2016. She remained in labour for 2 days before delivery. After three days of delivery, she presented with continuous leaking of urine. She had to wear sterile pads most of the time for protection. Her medical history was unremarkable. This patient had complete total longitudinal disruption of all the muscular elements of the urethral sphincter. The diagnosis of longitudinal disruption of urethral sphincter was made followed by primary reconstruction with an approximation technique M. M. Koraintin et al. (1) The muscular elements were approximated taking care not to strangulate the tissues by overtightening the knots. A simple suture technique was used rather than mattress suture as in the case of anal sphincter repair. DIFFERENTIAL DIAGNOSIS Vesicovaginal Fistula This is an abnormal fistulous tract extending between the bladder and vagina that allows continuous involuntary discharge of urine into vagina (Lee RA et al 1988 (2)). Ureterovaginal Fistula This is a communication between the distal ureter and the vagina. The urine from the ureter bypasses the bladder and flows into vagina (Gerber GS et al 1993 (3)). Urge Incontinence This occurs when one has a strong sudden need to urinate. The bladder then squeezes or undergoes spasm and they leak urine. Stress Incontinence This is the involuntary loss of urine on coughing, sneezing, running or heavy weight lifting. Overflow Incontinence This is the involuntary release of urine. Due to weak bladder muscles or due to blockage-when the bladder becomes overly full, even though the person feels no urge to urinate.