Urethral injury

Question 1

how to do urethrogram

Answer 1

catheter
2mls balloon
x ray plate under pelvis
20mls dilute IV contrast 10ml contrast +10mls saline
hold catheter in place and inject
AP x ray, lateral if possible. x ray at 30 degrees to patient

Question 2

co-exsiting rectal injury

Answer 2

5% of cases

blood on DRE

Question 3

when would do flexi to diagnose urethral injury

Answer 3

Flexible cysto-urethroscopy is preferred to RUG in suspected penile fracture-associated urethral injury as RUG is associated with a high false-negative rate

In females, where the short urethra often precludes adequate radiological visualisation, cysto-urethroscopy and vaginoscopy are the diagnostic modalities of choice

Question 4

anterior injury immediate vs delayed

Answer 4

The long term-outcomes (patency rate, potency rate) of patients treated with immediate urethroplasty is similar to these initially treated with suprapubic diversion and delayed urethroplasty.

Question 5

when would do immediate repair anterior injury

Answer 5

penile fracture

non life threatening penetrating

Question 6

rate of ED with PFUI

Answer 6

80% some degree ED

average rate ED 50%

Question 7

which injury may be cured with diversion alone

Answer 7

partial blunt anterior urethral ruptures
complete blunt unlikely
partial posterior injuries may also heal

Question 8

risks of immediate urethroplasty in PFUI

Answer 8

higher rate bleeding
stricture
incontinence
and ED compared delayed urethroasplty

Question 9

success of delayed urethroplasty with PFUI

Answer 9

86% with diversion and delayed urethroasplty for complete rupture

Question 10

EAU guidelines endoscopic relaignment

Answer 10

early endoscopic realignment in male PFUI when feasible

Question 11

EAU guidelines repair anterior injury

Answer 11

Treat complete blunt anterior urethral injuries by immediate urethroplasty, if surgical expertise is available, otherwise perform suprapubic diversion with delayed urethroplasty.

Treat partial blunt anterior urethral injuries by suprapubic or urethral catheterisation.

Question 12

how to do cystogram

Answer 12

Catheter Cystogram:
• Usually in Resuscitation room.
• X-ray plate under pelvis.
• 300ml dilute IV contrast medium (150 ml contrast + 150 ml saline).
• Push catheter in a further 2-3 cm so balloon not blocking bladder neck.
• Inject contrast down catheter with bladder syringe and clamp catheter.
• AP Pelvis x-ray taken. Additional lateral if possible.
• Evacuate contrast and repeat AP Pelvis x-ray.

Question 13

urethral injury in penile fracture repair

Answer 13

debride ends
spatulate
everting suture
4/0 monocryl
2 layers

Question 13

urethral injury in penile fracture repair

Answer 13

debride ends
spatulate
everting suture
4/0 monocryl
2 layers

Question 14

situations for primary anastomosis 4

Answer 14

penile fracture repair
bulbar less than 2cm
fall astride short traumatic injury
posterior urethral injury

Question 15

management of PFUI

Answer 15

initial conservative
fix pelvic fracture
put in SPC
antibiotics
repair bladder injury
ambulant at 3-6 months
retrograde urethrogram +/- antegrade urethrogram
flexi through SPC tract to see where level of transection is
if bladder neck injury will likely need sphincter
if can see veru can do primary anastomosis but external sphincter will be non functioning
warm them post urethroplasty no TUR procedures

Question 16

indications primary repair 48 hours 5

Answer 16

The indications for primary (within 48 hours) urethral repair are:
associated ano-rectal injury,
perineal degloving
bladder neck injury,
massive bladder displacement
and penetrating trauma to the anterior urethra.