URETHRAL TRAUMA IN MALES - IMMEDIATE AND DELAYED TREATMENT

Czech version

Authors: doc. MUDr. Radim Kočvara, CSc.
Authors‘ workplace: Urologická klinika 1. LF UK a VFN, Prahakatedra urologie a subkatedra dětské urologie IPVZ, Praha
Published in: Urol List 2005; 3(1): 26-32

Overview

The autor gives an overview of therapy of a urethral trauma in males. Use of retrograde urethrography is emphasized over a blind catheterization. The way to manage the urethral trauma depends on the status of the patient and on the burden and location of the injury - anterior or posterior urethra, partial or complete rupture. Immediate repair within 48 hours is indicated in penetrating or associated injuries, in acute bleeding or from orthopedic indication. Drainage of the bladder is usually obtained by a suprapubic tube; in case of a partial rupture, a gentle insertion of a permanent catheter is an option, best using X ray or endoscopic control.

The delayed primary management is performed between 2-14 days after the trauma with the goal of primary realignment of the urethra. It is feasible in a stabile patient only and endoscopic realignment is usually used. The deferred treatment is performed 3 months or later after the trauma. It consists in resection and anastomosis in case of anterior urethral stricture or in the transperineal bulbo-prostatic anastomotic urethroplasty in case of posterior urethral distraction. A good long-term result may be achieved in experienced hands in 90 % of patients. The urinary continence is preserved in most patients, the incidence of impotence is high and is mostly dependent on the primary injury.

KEY WORDS:
urethral trauma in males, retrograde urethrography, transperineal bulbo-prostaticanastomotic urethroplasty

Sources

1. Basiri A, Shadpour P, Moradi MR et al. Symphysiotomy: a viable approach for delayed management of posterior urethral injuries in children. J Urol 2002; 168: 2166-2169.

2. Colapinto V, McCallum RW. Injury to the male posterior urethra in fractured pelvis: a new classification. J Urol 1977; 118: 575-580.

3. Elliot DS, Barrett DM. Long-term follow up and evaluation of primary realignment of posterior urethral disruptions. J Urol 1997; 157: 814-816.

4. Ennemoser O, Colleseli K, Reissigl K, Poisel A, Poisel S, Janetschek G, Bartsch G. Posttraumatic posterior urethral strictures repair: anatomy, surgical approach and long-term results. J Urol 1997; 157: 499.

5. Fiala R, Záura F. Operační řešení posttraumatických distrakčních defektů uretry. Čes Urol 1998; 2(5): 26-28.

6. Fiala R, Záura F, Reif R. Striktura a trauma mužské uretry. Praha: StudiaGeo 1998: 135.

7. Fishman I, Hirsh IH, Toombs BD. Endourological reconstruction of posterior urethral disruption. J Urol 1990; 144: 76-78.

8. Flynn BJ, Delvecchio FC, Webster GD. Perineal repair of pelvic fracture urethral distraction defects: experience in 120 patients during the last 10 years. J Urol 2003; 170: 1877-1880.

9. Ghelier EL, Frontera JR. Immediate primary realignment of prostatomembranous urethral disruptions using endourologic techniques. Urology 1997; 49: 596-599.

10. Goel MC, Kumar M, Kapoor R. Endoscopic management of traumatic posterior urethral stricture: early results and follow-up. J Urol 1997; 157: 95-97.

11. Guille F, Cipolla B, Leveque JM, Guirassy S, Olivo JF, Lobel B. Early endoscopic realignment of complete traumatic rupture of the posterior urethra. Br J Urol 1991; 68: 178-180.

12. Chapple C, Barbagli G, Jorda G, Mundy AR, Rodrigues-Netto N, Pansadoros V, McAninch JW. Consensus statement on urethral trauma. BJU Int 2004; 93: 1195-1202.

13. Harriss DR, Beckingham IJ, Lemberger RJ, Lawrence WT. Long-term results of intermittent low-friction self-catheterization in patients with recurrent urethral strictures. Br J Urol 1994; 74: 790-792.

14. Herschorn S, Thiljssen A, Radomski SB. The value of immediate or early catheterization of the traumatized posterior urethra. J Urol 1992; 148: 1428-1431.

15. Hora M, Zeman J, Kastner J, Chudáček Z, Pradl R, Droppa J, Pavelka T. Urologické komplikace úrazů pánve. Rozhl Chir 2003; 82: 129-137.

16. Janský M. Poranění močové trubice. In: Dvořáček J et al. Urologie. Praha: ISV 1998: 662-667.

17. Jordan GH, Schlossberg SM. Surgery of the penis and urethra. In: Walsh PC et al (eds). Campbell's Urology. 8. ed. Philadelphia: WB Saunders 2002; 4. vol: 3886-3954.

18. Kočvara R, Dvořáček J, Kříž J. Uretroplastika stopkatým lalokem onlay v léčbě striktury uretry. Rozhl Chir 1998; 77(11): 493-496.

19. Kopecký J. Poranění močové trubice a močového měchýře. Urologie pro praxi 2004; 5: 201-204.

20. Koraitim MM. Pelvic fracture urethral injuries. Evaluation of various methods of management. J Urol 1996; 156: 1288-1291.

21. Koraitim MM. Posttraumatic posterior urethral strictures in children: a 20-year experience. J Urol 1997; 157: 641-645.

22. Ku JH, Kim ME, Jeon YS, Lee NK, Park YH. Management of bulbous urethral disruption by blunt external trauma: the sooner, the better? Urology 2002; 60: 579-583.

23. Lynch D, Martinez-Pineiro LM, Plas E, Serafetinidis E, Turkeri L, Hohenfellner M. Urethral trauma. Guidelines on Urological Trauma. European Association of Urology 2003. http://www.uroweb.org/files/ uploaded_files/guidelines/urotrauma.pdf.

24. McAninch JW, Santucci RA. Genitourinary trauma. In: Walsh PC et al (eds). Campbell's Urology. 8. ed. Philadelphia: WB Saunders 2002; 4. vol: 3707-3744.

25. MacDiarmid S, Rosario D, Chapple CR. The importance of accurate assessment and conservative management of the open bladder neck in patients with pelvic fracture membranous urethral distraction defects. Br J Urol 1995; 75: 65-67.

26. Morávek P, Šváb J. Intubační plastika striktury zadní uretry. Rozhl Chir 1995; 74: 357-360.

27. Morey FA, McAninch JW. Reconstruction of posterior urethral disruption injuries: outcome analysis in 82 patients. J Urol 1997; 157: 506-510.

28. Mundy AR. The role of delayed primary repair in the acute management of pelvic fracture injuries of the urethra. Br J Urol 1991; 68: 273-276.

29. Mundy AR. Urethroplasty for posterior urethral strictures. Br J Urol 1996; 78: 243-247.

30. Mundy AR. Transperineal bulbo-prostatic anastomotic urethroplasty. World J Urol 1998; 16: 164-170.

31. Oosterling W. Controversies in management of urethral trauma after pelvic fracture in men. Course book - ESU organized Course. October 2004, Tbilisi, 131-142.

32. Park S, McAninch JW. Straddle injuries to the bulbar urethra: management and outcomes in 78 patients. J Urol 2004; 171: 722-725.

33. Podesta ML, Medel R, Castera R et al. Immediate management of posterior urethra disruption due to pelvic fracture: therapeutic alternatives. J Urol 1997; 157: 1444-1448.

34. Podesta ML. Use of the perineal and perineal-abdominal (transpubic) approach for delayed management of pelvic fracture urethral obliterative strictures in children: long-term outcome. J Urol 1998; 160: 160-164.

35. Turner-Warwick R. A personal view of the management of traumatic posterior urethral strictures. Urol Clin North Am 1997; 4: 111-124.

36. Webster GD, Mathes GL, Selli C. Prostatomembranous urethral injuries. A review of the literature and a raional approach to their management. J Urol 1983; 130: 898-902.

37. Zvara V, Horňák M. Long-term results of treatment of urethral strictures by transpubic urethroplasty. Czech Med 1986; 9: 1.

Labels

Paediatric urologist Urology

PRESENT VIEW OF URETERAL INJURIES

RENAL TRAUMA AND THE PRESERVATION OF RENAL PARENCHYMA

BLADDER TRAUMA

INJURIES TO THE EXTERNAL GENITAL ORGANS

TRAUMA OF INERVATION OF LOWER URINARY TRACT

BLOOD CARE AT ELECTIVE UROLOGICAL OPERATIONS

OPTIMAL METHOD OF INTRAABDOMINAL PRESSURE MEASUREMENT

STRESS URINARY INCONTINENCE IN WOMEN AND ITS PHARMACOLOGIC TREATMENT OPTIONS

Article was published in

Urological Journal

2005 Issue 1