What Is Urethral Trauma?

Urethral trauma

[Overview]

Urethral Trauma

Male urethra is divided into anterior and posterior urethra. Anterior urethral trauma is mostly in the bulbous urethra, and posterior urethral trauma is mostly in the membrane urethra. Due to the greater mobility of the penile urethra, there is less chance of trauma.

Urethral trauma in women

The female urethra is short and straight, and there is less chance of injury. Male urethral trauma is usually a common urinary trauma.

Classification of urethral trauma and its causes

Introduction of urethral trauma

Closed injury:

(1) Ball urethral trauma: The perineum rides on a hard object, and the ball urethra is injured due to the compression of the pubic arch and the hard object.

(2) Membrane urethral trauma: Violence may cause pelvic fractures, puncture the urethra, or the urethrogenital diaphragm may be caused by displacement of the fractured part, which may cause urethral trauma.

(3) Intraurethral trauma: mostly iatrogenic injuries, improper use of various urethral instruments such as urethral probes, metal urethral catheters, cystoscopes or transurethral resectoscopes, ureters Caustic drugs can damage the urethra.

Introduction of urethral trauma and open injury

Open injury:

Seen during wartime firearm injuries usually knife or human or animal bites. Firearm injuries are often accompanied by combined injuries.

Urethral trauma can be divided into contusion, partial rupture and complete rupture according to the degree of injury.

Diagnosis of urethral trauma

Routine diagnosis of urethral trauma

(1) Trauma history: Injury of the ball caused urethral injury. Pelvic fractures often cause membrane urethral damage.

(Two) clinical manifestations:

1. Shock: Bulb urethral injuries are generally not accompanied by shock. Membrane urethral trauma is associated with pelvic fractures, causing a large amount of bleeding, and about half of the wounded have shock. Pay attention to the observation of vital signs at the time of admission.

2. Urethral bleeding: blood flows from the urethral orifice after injury, and has nothing to do with urination. Membrane urethra or completely broken wounds have less chance of bleeding through the outer urethra.

3 Dysuria: due to pain and sphincter spasm, bladder bloating and urination sensation, unable to excrete urine. Do not force the wounded to urinate during the consultation to avoid causing or aggravating extravasation.

4 Urinary extravasation: the hematoma and extravasation of the bulbous urethral trauma are in the perineum, which can spread to the scrotum and penis or to the lower abdominal wall, but do not extend to the femur (Figure 6-9). Membrane urethral trauma is all around the bladder above the urogenital ridge. Anal finger examination can reveal that the anterior rectum is full and fluctuating. If it is a complete rupture injury, the prostate can float or shift.

Differential diagnosis of urethral trauma

(Three) diagnostic catheterization

The catheter was blocked on the wound and a small amount of blood flowed out. In the case of partial trauma, the urinary catheter may be slightly obstructed, but it can still be inserted later, and there is anterior hematuria and a clear urine in the posterior section. If the urinary catheter can be introduced into the bladder, it can be left intact as one of the treatment measures for urethral trauma.

(4) X-ray inspection:

Plain films can diagnose pelvic fractures. Contrast agent is injected from the urethral orifice for urethral angiography. It can be seen that the contrast agent overflows from the damaged area, so that the damage site and the extent of extravasation of urine can be known.

Differentiation from bladder trauma:

Pelvic fractures can cause membrane urethral trauma and can cause extraperitoneal rupture of the bladder. Attention should be paid to identifying several points: after the bladder is ruptured, there is no self-bleeding at the outer urethra; there is no filling and swollen bladder in the upper pubic area; the catheter is inserted smoothly but no urine flows out; . Urinary tract damage is contrary to the above points. However, if both are traumatized at the same time, the diagnosis is difficult, and it is difficult to judge or distinguish. The diagnosis must be confirmed by surgical exploration.

Urethral Trauma Treatment

Urethral Trauma Treatment Principles

(I) Principles of urethral trauma treatment: correct shock, drain urine, restore urethral continuity, drain extravasation, and prevent urethral stricture.

(II) Specific method: When performing a diagnostic catheterization, if it is confirmed that the urethra has been traumatized and the catheter can be placed in the bladder, leave it for 3 weeks and periodically dilate after extubation.

Bulb urethral trauma: urethral repair and bladder fistula, urethral anastomosis with valgus mattress suture method, the effect is satisfactory, and regular dilation is not necessary. If the injured person comes to the clinic late and has local infection, he should only be used for bladder fistula, and multiple incisions and drainage should be made for extravasation of the urine, for later treatment.

Membrane urethral trauma: At present, domestic treatment methods have not been consistent. There are three main types:

(1) Traction of urethral meeting: After the wounded has no shock or the shock has been corrected, the bladder is cut on the pubic bone, and the balloon catheter is built into the wire with a curvature similar to the curvature of the urethral probe. Use your fingers to reach the inside of the urethra. In the urethra, you can touch the top of the catheter and introduce it into the bladder. The balloon was filled with 15-20 ml of blue dyed sterile liquid. After returning to the ward, the balloon catheter was pulled in a 45 degree direction, and the traction was reset by about 500 grams. After three days, the weight was reduced. The traction was stopped after one week, and the tube was removed after 3 weeks. Urine dilation. This method has a high success rate and minimal damage.

(2) Immediately after shock correction, perform a one-stage urethral anastomosis and bladder fistula.

(3) After the injury, a bladder fistula is performed first. If there is difficulty in urination after three months, the stenosed section is removed and then anastomosis is performed.

If rectal trauma is involved, colostomy and bladder fistula are performed, and the urethra is repaired in two stages.

Principles of prevention and treatment of urethral trauma

Prevention and treatment of urethral stricture

After urethral trauma due to improper handling or severe infection, urethral stricture is often caused. It happened earlier, and most of them had symptoms within three months. Severe cases can cause complete urinary retention. Urethral strictures are often accompanied by chronic infections or periurethritis, periurethral abscesses, and urinary fistulas. This makes handling more difficult. Metal urethral probing strips can be used for diagnosing urethral strictures. Adults who do not pass F16 can be considered stenoses; X-ray urethral angiography can understand the location, extent and length of stenosis, and those with less severe urethral strictures can regularly expand urethra. When expansion fails or multiple expansions do not improve, surgical treatment should be considered. Various methods are selected according to the condition of the stenosed segment, such as resection and anastomosis of the stenosed segment, urethral application, and flap or bladder mucosa for urethroplasty. It is very important to prevent the early treatment of urethral stricture, and to achieve a satisfactory anastomosis, the anastomosis should be wide. Control the infection after surgery, followed by regular urinary dilatation.

What should I do for urethral trauma

Anal finger examination can reveal that the anterior rectum is full and fluctuating. If it is a complete rupture injury, the prostate can float or shift.

X-ray examination: plain film can diagnose pelvic fractures. Contrast agent is injected from the urethral orifice for urethral angiography. It can be seen that the contrast agent overflows from the damaged area, so that the damage site and the extent of extravasation of urine can be known.

Diagnostic urinary catheterization: The catheter is blocked on the wound and a small amount of blood flows out. In the case of partial trauma, the urinary catheter may be slightly obstructed, but it can still be inserted later, and there is anterior hematuria and a clear urine in the posterior section. If the urinary catheter can be introduced into the bladder, it can be left intact as one of the treatment measures for urethral trauma.