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URETHRAL TRAUMA IN MALES - IMMEDIATE AND DELAYED TREATMENT


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


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