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العنوان
PRIIMARY MANAGEMENT OF URETHRAL
TRAUMA IIN MALES /
المؤلف
Shehada,Hossam Fayek.
هيئة الاعداد
باحث / Hossam Fayek Shehada
مشرف / Hany Hamed Gad
مشرف / Mohamed Ahmed Gamal Al-Deen
تاريخ النشر
2015
عدد الصفحات
134p.:
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
جراحة المسالك البولية
تاريخ الإجازة
1/1/2015
مكان الإجازة
جامعة عين شمس - كلية الطب - جراحة المسالك البولية
الفهرس
Only 14 pages are availabe for public view

from 134

from 134

Abstract

Urethral injuries, by themselves, are never life-threatening, except as a consequence of their close association with pelvic fractures and multiple organ injuries, which occur in about 27% of cases. Initially, the assessment and management of other associated injuries are usually far more important than the assessment and management of the urethral injury (Chapple and Prig, 1999).
The male urethra is divided into the anterior and posterior sections by the urogenital diaphragm. The posterior urethra consists of the prostatic and the membranous urethra. The anterior urethra consists of the bulbar and penile urethra (Chapple and Prig, 1999).
The antero-posterior and lateral compression types of fracture, while vastly different, may be associated with both stable and unstable subtypes. The vertical shear fracture is always unstable; the latter, described by Malgaigne in 1855, consists of a fracture anteriorly through both rami of the symphysis pubis, in association with massive posterior disruption, either through the sacrum, the sacro-ili accurate diagnosis of urethral injury is difficult, and there may be no convincing differences on urethrography between partial and complete transactions. A partial disruption is noted when contrast material is seen to extravasate at the site of injury and at least a portion of it also passes through the prostatic urethra and into the bladder. Complete disruption demonstrates extravasation at the site of injury onlyac joint or the ilium (Pokorny et al., 1979).
When the urethra is ruptured, blood is present at the urethral meatus in the majority of patients. Other signs of urethral injury may include a patient‘s inability or difficulty with voiding; non palpable, distended bladder; or the inability to pass a urinary catheter into the bladder (Moudouni et al., 2001 & Morey and Rozanski, 2007).
Retrograde urethrography is considered to be the best initial study for urethral and periurethral imaging in men and is indicated in the evaluation of urethral injuries, strictures, and fistulas (Akira et al., 2004).
Posterior urethral injuries were managed by early intervention to realign or repair the urethra and drain the pelvic hematoma. This approach was associated with an unacceptably high rate of impotence and incontinence, so a shift toward a more conservative approach using immediate suprapubic catheter drainage followed by delayed urethroplasty . With the recent advances in endoscopic techniques and the realization that, in general, the magnitude of the injury rather than the initial management is responsible for the impotence and incontinence, the approach to managing these injuries is again mired in controversy (Webster et al., 1985).The following treatment strategies are available for acute management:
1. Primary open suturing of the disrupted urethra.
2. Endoscopic or surgical realignment by insertion of a transurethral »railroad« catheter.
3. Suprapubic cystostomy and delayed repair.
4. Acute surgical intervention is indicated for the following:
A. Concomitant rectal tear.
B. Bladder neck laceration.
C. Serious, life-threatening bleeding, mainly from the inferior or superior gluteal arteries (Koraitim et al., 2011)
The procedure of choice should be individualized, depending on
 The anatomy
 Extent of the urethral injury,
 Stability of the patient
 Presence of additional injuries
Early realignment of urethral disruption is possible in some patients with trauma and it may decrease the requirement for subsequent urethral stricture therapy by 50%. This procedure does not appear to increase the rate of impotence or incontinence and strictures that occur after early realignment may be easier to treat.