Initial Management of Acute Urethral Injuries

Abstract

A study was made of 30 cases of acute urethral trauma treated over a 7-year period. There were 10 anterior and 20 posterior urethral injuries, the majority of these being partial ruptures. Posterior urethral injuries were caused by road traffic accidents in 75% of cases while 80% of the anterior urethral injuries were of the "straddle" type. There was only 1 case of iatrogenic injury to the anterior urethra. During follow-up, all patients required periodic dilatations for stricture except for the single case of iatrogenic injury. An average of 5 dilatations controlled all of the strictures except for 2 that required urethroplasties.

Urethral trauma. Part I: introduction, history, anatomy, pathology, assessment and emergency management

“…Our experience is that partial injuries predominate in all locations [57]. Others are of the same opinion [59,76], including the author of the only study we are aware of in which routine urethroscopy was undertaken 2–3 weeks after injury in all patients and when the only previous treatment was SPC [59]. Interestingly, all three reports also show that although it may be theoretically true that after an incomplete injury healing is possible without stricture formation, in practice a stricture almost always occurs.…”

“…The cardinal features of urethral injury are urethral bleeding and voiding difficulty due to ‘reflex retention’ leading to a palpable bladder. In patients with a PFUI, a displaced or impalpable prostate on rectal examination was a third feature [4,11,12,15,16,24,25,59,76–78]. Indeed the findings on rectal examination were deemed critical to the distinction between a PFUI and a ruptured bladder [78,79].…”

“…In the era before modern catheters and antibiotics this was certainly possible, by causing further trauma and increasing the risk of infection [6,33,34,59]. Nowadays, with modern catheters and antibiotics, this is probably not so [60,76,81], as long as it is not assumed that a small amount of blood‐stained fluid means that the catheter is in the bladder because it almost certainly is not [25,82,83]; and as long as it is not assumed that if the catheter goes into the bladder that there is no urethral injury, because there sometimes is [59,60]. In practice many, if not most patients in an emergency setting are catheterised routinely, before they are seen by a urologist, and only have urethrography if catheterisation fails.…”

Harnröhrentraumen

“…Wenn gleich Blut am Mea tus in di ka tiv für eine HR-Lä si on ist (in 37-93 der Fäl-le vor lie gend [30,31]) und eine sorg fäl tige Ab klä rung im pli ziert, bleibt die ses Anzei chen nicht Be weis, so dass im Um kehrschluss das Feh len von Blut spu ren kei neswegs eine HR-Mit be tei li gung aus schließt. Im Fal le von Blut spu ren soll te da her vor dem Ver such ei ner Ka the ter an la ge pri mär eine re tro gra de Ure thro gra phie (RUG, vgl.…”

Management traumatischer Läsionen von Harnblase und Urethra

“…Leitsymptom der Urethraruptur ist der Blutaustritt am Meatus urethrae externus, der in bis zu 93% der Patienten nachweisbar ist [26,30]. Weitere Symptome können eine Hämaturie, Dysurie oder auch ein Harnverhalt sein.…”