Acute surgical treatment of posterior urethral injuries

     【Key Words】 Acute posterior urethral injury

     Male pelvic fracture caused by posterior urethral injury is the most difficult urological injury, acute illness and weight. Now our hospital

    since March 1992 to March 2004 collected 34 cases of treatment of patients with posterior urethral injuries, the report is as follows.

     A clinical data

     1.1 General Information

     34 patients, aged 15 to 68 years old, with an average 31-year-old.

    Complete posterior urethral rupture are associated with pelvic fracture complicated with shock in 16 cases, 9 cases of bladder rupture, blood pneumothorax, rupture of spleen in 2 cases, intestinal rupture in 4 cases. Injury causes: traffic accidents in 26 cases, eight cases of injury

    falling height. 34 cases in 31 cases of closed injury, 3 cases of open perineal urethral injury.

     1.2 Treatment

     Correct shock, diagnosis and treatment of combined injury, hospitalization, within 12h after the surgery to be urethral rupture. 23 of them after a routine urethral realignment traction: intraoperative I bear a set of metal spies Foley catheter, from the mouth into the urethra, and then use the left index finger into the posterior urethra and urethra

    spies joined forces to Foley catheter into the bladder, to within the red balloon with normal saline 20 ~ 30ml, along with the body axis of 45 ? to

    the wheel traction, the former 3d pulling force of 400 ~ 600g, after 3 ~ 4d to 200 ~ 300 grams. 9 cases (including three cases of open injury)

    passing through anastomosis perineal urethral rupture, of which four cases of proximal urethra to find difficult to cut line after the bladder

catheter inserted from the inside out to find the proximal urethra. 2

    patients in critical condition due to a simple line of bladder fistulization.

     2 Results

     23 cases of posterior urethral realignment with traction, 3 ~ 6 weeks removal of catheters, of which 16 cases of postoperative voiding smooth, 2-year follow-up results were satisfactory; four cases of removal of urinary catheter after 4 weeks of thinner line, multiple urethral dilation unobstructed voiding. 2 cases of dysuria after catheter removal, and more difficult to expand the urethra, urinary tract imaging of posterior

    urethral stump are misplaced, at the outer urethral anastomosis. 1 patient developed urinary fistula Across the bladder fistulization. There was no occurrence in patients with impotence.

     Passing through the perineum or abdominal perineal anastomosis of the

    urethra in 9 cases, 3 weeks after removal of catheters, including 7 cases of voiding, 2 patients after repeated voiding after urethral dilatation. Four cases of varying degrees of impotence.

     Simple line bladder fistulization in 2 cases, 1 case died of multiple organ injury in hemorrhagic shock, and 1 month later, five urethral anastomosis, postoperative voiding. Reposted elsewhere in the paper for free download http://

     3 Discussion

     Urinary problems dealt with one injury, injury site in the urogenital septum above, after the pubic symphysis, multiple pelvic fractures, surgery revealed difficulties, prone to urinary incontinence, urethral stricture. Posterior urethral injuries caused mainly by the unexpected

    violence, is often associated with a complex injury. Was more serious and complex disease, hemorrhagic shock is a common manifestation and is the leading cause of death. In correcting the shock, the right to deal with other emergency surgery, urethral stricture, and impotence, for late

    complications. Combined combined injury with posterior urethral injury accompanied by varying degrees of shock over its emergency management principles are: early lifting of urine retention, and complete drainage of urine extravasation, as far as possible

     To restore urethral continuity, to prevent complications such as urethral stricture and the occurrence of impotence. Emergency surgery, including

simple bladder fistulization, urethral anastomosis repair and urethral

    realignment traction. Although the traction of urethral realignment of posterior urethral stricture is still possible to re-occlusion, but

    because this operation has been to break the initial reset the urethra, urethral stricture in a relatively short distance, but also for the two

    operations to create a better alignment condition of the urethra. Urethral realignment traction simple, little injury, after pulling the extent possible, consistent with two stump in order to reduce opportunities for urethral stricture scar, urethral realignment traction urethral rupture can restore continuity, in line with the rapid growth of urethral mucosa characteristics [1]. The surgery on patients with severe combined injury or inadequate conditions at the grassroots level hospital, the doctor is

    limited circumstances be regarded as a better approach, postoperative urethral stricture, the low incidence of impotence. Authors believe that early treatment of posterior urethral injury should be considered in patients with specific conditions and medical treatment permit conditions accordingly. Pairs accompanied by shock or organ damage associated with other important persons, active in anti-shock treatment and save the other

    vital organ function after urethral injury discretion. 2 patients in this

    group are in shock and coma, while associated with other organ damage, so choose a simple bladder fistulization. This method has [2]: (1) does not increase bleeding and pelvic nerve damage, to protect patient safety and reduce the incidence of impotence. (2) reduction of hematoma infection and local tissue fibrosis, which will help post-urethroplasty. (3) does not

    damage external sphincter in the future to do when the bladder neck or prostate, urinary incontinence does not occur. (4) To avoid some of the

    urethral catheter urethral rupture into a complete fracture. Operation simple, safe, but takes 3 ~ 6 months after the re-operation, while the two

    surgical stump a result of two separate, long segment stricture urethral defects and increase the surgical difficulties, extended treatment time. In this group simply line the bladder fistulization in 2 cases, 1 case died of multiple organ injury in hemorrhagic shock, and 1 month later, five urethral anastomosis, postoperative voiding. Urethral realignment

    traction should not be soft when the air bag should be big time 7 ~ 10d is appropriate. Time to pull catheter can be properly extended to 5 ~ 6 weeks after operation, postoperative urethral dilatation is best in person by the surgeon operating, expansion device used when the expansion should not be too thick, in order to "No. 22 is appropriate, so as not to give rise to new injury. Perineal or abdominal perineal urethral anastomosis is more complicated surgery in time to remove the hematoma and extravasation of

    urine, urethral stump at the same time while achieving a smooth fit, thus better reduce the urethral stricture and urethral scar around the scar contraction in the incidence of stenosis, Therefore, as long as the patients with general permits, the pelvic ring stability, technical

    conditions are ripe, may be preferred to the surgery, but the incidence of postoperative erectile dysfunction was significantly higher than realignment with traction. Operative iatrogenic injury induced impotence is caused by a very important reason why [3]. Wang et al [4] that the occurrence of erectile dysfunction pelvic fracture injury mechanisms, but not with urethral realignment with traction operation has nothing to do. Therefore, immediately after injury urethral realignment traction, will

    not increase the incidence of erectile dysfunction. To join forces in this group had no traction in patients with impotence occurs. In the perineum,

or abdominal perineal urethral anastomosis to minimize the spin-off and

    damage the tissues around the prostate membranous urethra in order to reduce the incidence of erectile dysfunction, although they separated retropubic space, gentle movements to avoid metal spies in the urethral stump to make a more substantial Stir. Early application of broad-spectrum

    antibiotics, followed by mouth under the urethral secretions or urine culture results to adjust the type and dosage of antibiotics. When the latter occurs when the urethral stricture or atresia should be based on

    urethrography surgical option for a narrow segment