1.5 Lesions of the urethra and the genital organs, their early and late consequences

Question 1

Etiology of Urethral lesions?

Answer 1

Traumas

Question 2

Etiology of urethral injuries in females?

Answer 2

traiumas
very rare
associated with gynecological and urological operations

Question 3

Etiology of urethral injuries in males?

Answer 3

posterior urethral trauma
Anterior urethral trauma:

Question 4

what is Anterior urethral trauma?

Answer 4

• solitary
• could be iatrogenic: by instrumentation (cystoscopies, catheters, dilators)
• could be Non-iatrogenic: straddle injures as a
  result of a direct kick to the perineum or a fall onto a bicycle crossbar or a fence.

Question 5

what parts anterior urethral injuries involve?

Answer 5

• Involves the bulbar part of the urethra
• A smaller portion of non-iatrogenic trauma involved direct penetrating injuries to the penis

Question 6

what is The primary morbidity of straddle injury?

Answer 6

urethral stricture

Question 7

what is posterior urethral injuries?

Answer 7

• Similar to extraperitoneal rupture of the bladder
• associated with fractures and gross disruption of the pelvis
• can be seen in conjunction with multisystem trauma

Question 8

symptoms of urethral injuries?

Answer 8

• bleeding from the urethral meatus
• inability to urinate,
• palpable full bladder
• “butterfly” perineal hematoma or “high-riding” prostate by physical examination are specific
• Vulvar edema and blood at the vaginal orifice (characteristic for posterior urethral injury in female due to pelvic fracture)

Question 9

Diagnosis of urethral injuries?

Answer 9

• During physical examination, blood at the urethral meatus
• Impalpable prostate
• Urethrography with water-soluble contrast medium
• Urethroscopy

Question 10

first line treatment of urethral injuries ?

Answer 10

Minor injuries are treated by urethral catherization for a week or longer

Question 11

alternative treatment as 2nd line therapy for urethral injuries?

Answer 11

a suprapubic catheter can be inserted, and the patient should be transferred to urology
(until the conditions are more favorable for repair)

Question 12

treatment of anterior urethral injury?

Answer 12

primary repair is the most favorable.

Question 13

treatment of posterior urethral injury?

Answer 13

1. Conservative approach includes inserting a
   suprapubic catheter and wait for better conditions.
2. An aggressive approach with primary anastomosis is used upon complete posterior urethral rupture.

Question 14

Penile trauma etiology?

Answer 14

• infrequent
• most commonly fracture caused by excessive bending force during sexual intercourse when the penis is thrust against the partner perineum or pubic symphysis.
• Most ruptures occur distal to the suspensory ligament

Question 15

Penile trauma symps?

Answer 15

• Cracking or popping sound as the tunica albuginea tears
• pain
• rapid detumescence of the shaf
• discoloration of the shaft
• swelling of the shaft

o The swollen penis often deviates to one side opposite to the tunica tear due to hematoma and mass effect

Question 16

Penile trauma diagnosis
?

Answer 16

• History and clinical presentation
• Cavernosography and US is discouraged due to being time-consuming and falsenegative rate
• Check for urethral injury

Question 17

penile trauma treatment?

Answer 17

Surgical intervention is advised without delay:
- The fracture must be explored and repaired with interrupted absorbable sutures
- Start wide spectrum antibiotics and sexual abstinence for 4-6 weeks

Question 18

treatment of penetrating penile injury?

Answer 18

• due to animal and human bites
• immediate exploration
• irrigation
• if necessary, excision
• Broad spectrum abx, tetanus and rabies prophylaxis

Question 19

Scrotal trauma etiology?

Answer 19

• Majority of testicular traumas: due to blunt injury (sport related, assaults, motor vehicle accidents)
• minority: penetrating injuries (gunshots,
  explosions)
• can result in rupture of the tunica albuginea.

Question 20

symps of scrotal traumas?

Answer 20

o severe scrotal pain and nausea

o Scrotal hemorrhage and hematocele present in almost all cases (swelling)

o Consider rupture of testis in all cases with scrotal trauma

Question 21

scrotal traumas diagnosis?

Answer 21

• Physical examination
• US: assess integrity of the tunica albuginea and blood supply

Question 22

treatment of scrotal trauma?

Answer 22

Surgical exploration as early as possible

Question 23

Scrotal skin injury or genital skin loss etiology?

Answer 23

• Fasciitis necrositans (Fournier´s gangrene) if life-threatening
• Polymicrobial infection
• Predisposing: Immune suppression, urinary or fecal alteration, poor hygiene

Question 24

Scrotal skin injury or genital skin loss treatment?

Answer 24

Multistep:
1. Debridement
2. drainage
3. necrectomy
4. Microbiological testing,
5. broad spectrum antibiotics