Urethral Trauma

Urethral trauma divided into two : - Anterior urethral trauma - Posterior urethral trauma Epidemiology Posterior urethral injuries are most commonly associated with pelvic fracture, with an incidence of 5%-10%. With an annual rate of 20 pelvic fractures per 100,000 population, these injuries are not uncommon.[1] Anterior urethral injuries are less commonly diagnosed emergently

 Etiology 1. Blunt trauma : posterior urethra related to massive deceleration events such as falls from some distance or vehicular collisions pelvic fracture. anterior urethra results from a blow to the bulbar segment such as occurs when straddling an object or from direct strikes or kicks to the perineum. 2. Penetration trauma : include gunshot and stab wounds. 3. Iatrogenic injuries to the urethra occur when difficult urethral catheterization leads to mucosal injury with subsequent scarring and stricture formation.

 Pathofisiology Anterior urethra in the corpus spongiosum wrapped together with the corpus cavernosa in the pack by the buck's fascia and Colles fascia Rupture of the urethra and the corpus spongiosum cause blood and urine finished but still in the Buck fascia When the fascia Buck is rupture urine and blood extravasation occurs only in coated by Colles fascia so that the blood spread to the scrotum and abdominal Butterfly Hematom

 clinical symptoms o posterior trauma: pelvic fracture, hematoma, injury, suprapubic and abdominal tenderness. o Stimulation peritoneum (+) if there is a ruptured bladder o anterior trauma: a bruise or hematoma in the penis and scrotum, a drop of blood in the urethral meatus o Total urethral rupture: can not micturition, pain in the lower abdomen and suprapubic o Injury due to catheter: obstruction due to edema or hematoma

 Physical examination blood at the meatus or a highriding prostate gland upon rectal examination. Extravasation of blood along the fascial planes of the perineum is another indication of injury to the urethra. The diagnosis of urethral retrograde urethrography Extravasation of contrast demonstrates the location of the rupture. Further management is predicated on the findings of urethrography in combination with the patient's overall condition.

 Procedures 1. Rupture of the posterior urethra without intraabdominal organ injury sistostomi, 2-3 days later do the anastomosis from end to end and insert the silicone catheter for 3 weeks 2. When accompanied by other organ injury can not repair shunt catheter 3. Ruptured anterior urethral total: anastomosis and attach the catheter for 3 weeks 4. Partial: sistostomi and attach foley catheter 7-10 days until epithelialization occurs urethral