Traumatic lesions of the posterior urethra

Velarde-Ramos, L.; Gómez-Illanes, R.; Campos-Juanatey, Félix; Portillo-Martín, J.A.

doi:10.1016/j.acuroe.2016.08.006

Cited by 3 publications

(7 citation statements)

References 33 publications

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“…A thorough clinical exam is essential for making a diagnosis of urethral injury. The most characteristic clinical sign of urethral injury in pelvic fractures is fresh or dry blood at the urethral meatus [ 3 ]. In fact, blood at the meatus is seen in 37 to 93% of PUI [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most characteristic clinical sign of urethral injury in pelvic fractures is fresh or dry blood at the urethral meatus [ 3 ]. In fact, blood at the meatus is seen in 37 to 93% of PUI [ 3 , 4 ]. However, the amount of blood present does not indicate the extent of the injury [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the amount of blood present does not indicate the extent of the injury [ 5 ]. The presence of a high-riding prostate has relatively low sensitivity in determining if a PFUI is present [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, certain pelvic fracture subtypes are associated with a higher risk for PUI, including diastasis of the sacroiliac joint and the Malgaigne fracture [ 53 , 58 , 59 ]. A Malgaigne fracture is caused by a vertical shear force leading to upward hemipelvis displacement and ipsilateral fracture of both pubic rami or pubic symphysis with associated sacroiliac dislocation or ipsilateral ilium [ 3 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Urethral trauma is defined as forceful damage to the urethra [ 1 , 2 ] and accounts for roughly 4% of all genitourinary trauma [ 1 , 2 ]. Urethral disruption occurs in approximately 10% of blunt pelvic trauma injuries, and in 35–40% of penetrating injuries to the penis [ 3 , 4 ]. Approximately 65% of both blunt and penetrating traumatic urethral injuries result in a complete urethral disruption, while the remaining 35% result in at least a partial urethral tear [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians

Patel

Osterberg

Satarasinghe

et al. 2023

JCM

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Urologic trauma is a well-known cause of urethral injury with a range of management recommendations. Retrograde urethrogram remains the preferred initial diagnostic modality to evaluate a suspected urethral injury. The management thereafter varies based on mechanism of injury. Iatrogenic urethral injury is often caused by traumatic catheterization and is best managed by an attempted catheterization performed by an experienced clinician or suprapubic catheter to maximize urinary drainage. Penetrating trauma, most commonly associated with gunshot wounds, can cause either an anterior and/or posterior urethral injury and is best treated with early operative repair. Blunt trauma, most commonly associated with straddle injuries and pelvic fractures, can be treated with either early primary endoscopic realignment or delayed urethroplasty after suprapubic cystostomy. With any of the above injury patterns and treatment options, a well thought out and regimented follow-up with a urologist is of utmost importance for accurate assessment of outcomes and appropriate management of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians

Patel

Osterberg

Satarasinghe

et al. 2023

JCM

View full text Add to dashboard Cite

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Reconstruction of Membranous Urethral Strictures

2018

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Non-traumatic strictures affecting bulbomembranous urethra are typically sequelae of instrumentation, transurethral resection of the prostate, prostate cancer treatment, and pelvic irradiation. Being a different entity from trauma-related injuries where urethra is not in continuity, a new understanding of membranous urethral anatomy is necessary for the development of novel reconstruction techniques. Although efficacious and durable to achieve urethral patency, classical bulboprostatic anastomosis carries a risk of de-novo incontinence and impotence. Newer and relatively less invasive reconstructive alternatives include bulbar vessel-sparing intra-sphincteric bulboprostatic anastomosis and buccal mucosa graft augmented membranous urethroplasty techniques. The accumulated experience with these techniques is relatively scarce, but several published series present promising results. These approaches are especially indicated in patients with previous transurethral resection of the prostate in which sparing of rhabdosphincter and the cavernous nerves is important in attempt to preserve continence and potency. Additionally, introduction of buccal mucosa onlay grafts could be especially beneficial in radiation-induced strictures to avoid transection of the sphincter in continent patients, and to preserve the blood supply to the urethra for incontinent patients who will require artificial urinary sphincter placement. The evidence regarding erectile functional outcomes is less solid and this item should be furtherly investigated.

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Epidemiology of posterior urethral injury among adults with traumatic pelvic ring disruptions: a 10-year retrospective review from a trauma care centre in Southeast Nigeria

Nnabugwu¹,

Obadaseraye²,

Anyimba³

et al. 2023

Pan Afr Med J

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Introduction posterior urethral injuries can occur in polytrauma settings, and may contribute to morbidity post-trauma. The aim of this study is to determine the occurrence of pelvic fracture urethral injury (PFUI) in adult polytrauma patients who were successfully stabilized and to appraise the nature of associated injuries. Methods the medical records of stabilized polytrauma patients≥ 18 years of age from January 2010 to December 2019 were retrospectively reviewed focusing on those presenting with bony pelvis disruptions. Injuries were categorized using the injury severity scale (ISS) while bony pelvis disruptions were classed according to the Young-Burgess classification. Data on the demography of the patient, mechanism of injury, nature, and severity of injuries, class of pelvic fracture-disruption, and urethral integrity were collected and analyzed accordingly. Results of 111 patients with bony pelvis disruptions, 95 of them had adequate information and were included in our analysis. The mean age of participants was 37.3 ± 11.8 years and most of them were males (87.4%). Blunt pelvic trauma occurred in 96.8%. Lateral compression pelvic injuries were prevalent at 39.0%. In 54.7% of the patients, the injury severity score (ISS) was ≥ 27. At 25.3% and 24.2% respectively, the abdomen and the lower extremities most frequently sustained a grade ≥ 3 injuries (abbreviated injury scale (AIS) ≥3). At a rate of 2.1%, spinal cord injury was the least observed. In the 10 years, there were 6 PFUI among 83 stabilized polytraumatized men with mean ISS of 35.5 ± 8.3. The incidence rate of PFUI was 0.6 per 8.3 pelvic disruptions in men per year. Symphysis pubis disruption or fracture of the pubis or both was consistently seen in all PFUI. Higher ISS significantly relates to PFUI (p <0.001). The mechanism of bony pelvis disruption and the class of bony pelvis injury are determined by the severity and trajectory of the impact apparently relates to PFUI only through fracture-disruption of the pubic symphysis or the pubis. Conclusion about 7.2% of men presenting with traumatic disruption of the bony pelvis in polytrauma setting sustain PFUI. In polytrauma settings, PFUI should be suspected in cases of fracture-disruption of the pubis or symphysis pubis from any mechanism.

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Traumatic lesions of the posterior urethra

Cited by 3 publications

References 33 publications

Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians

Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians

Reconstruction of Membranous Urethral Strictures

Epidemiology of posterior urethral injury among adults with traumatic pelvic ring disruptions: a 10-year retrospective review from a trauma care centre in Southeast Nigeria

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