injuries to male urethra

بسم الله الرحمن الرحيم

Injuries to the male urethra
By
Dr.Zaid Saadeldin khudher
MBChB,FIBMS,FEBU

Anatomy

Rupture of the bulbar urethra
History of a blow to the perineum usually due to a fall a stride a projecting object
Clinical Features :The triad of signs is retention of urine , perineal hematoma & bleeding from the ext. urinary meatus

Preliminary assesment & treatment

Analgesic Drugs
Discourage patient from passing urine& if bladder is full perform percutaneous suprapubic cystostomy((this will reduce the likelyhood of urinary extravasation &allow appropriate investigations to establish the full extent of urethral injury))

Kit for percutaneous suprapubic drainage of the bladder.

Treatment of rupture bulbar urethra

Its controversial ,the main warry is that injudicious catheterisation will convert partial into complete transection of the urethra
more information obtained by ascending urethrogram or flexible cystoscopy to asses the inj.
If complete tear of the urethra then leave suprapubic catheter until repair

Treatment..(cont.)

Some surgeons advocate early open repair of urethra with excision + spatulation + end to end anastamosis of the urethra
Other surgeons wait longer

Complications

Subcutaneous extravasation of urine in complete rupture if the patient attempt to pass urine.
stricture is common sequel whether there is partial or complete tear
infection




Rupture of the Membranous Urethra
Intrapelvic rupture of membranous urethra occurs near the apex of the prostate

Clinical Features

Two types of fracture pelvis .. 1.hemipelvic displacement 2.butterfly fracture
about 10-15%of cases of fractured pelvis have associated urethral inj.
There is often multiple trauma with inj to head thorax & abdomen

Clinical features (cont.)

The type of ureth. inj. can often be deduced from the plain radiograph
There may be associated inj. to the bladder with either intra or extra peritoneal rupture
Intraperitoneal rupture associated with peritonitis

Clinical features (cont.)

Extra peritoneal rupture of the bladder cause symptoms like rupture memb.urethra
if the prostate is displaced it may be impossible to reach or appear to be very high on DRE

Treatment :

ABC..to keep patient a live
the ureth. Inj.can be managed in the short term by inserting a suprapubic cath.
Intraperit. rupture of UB=exploration &repair of UB
Extraperit. rupture ofUB=repair +suprapubic cath.+retroperit. drain

Complications:

1.Urethral stricture
2.Urinary incontinence: if the ext. urethral sphincter is destroyed continence will depend upon competence of bladder neck mechanism
3.Impotence..this is the result of damage to the nerve supply of penis
4. Extravasation of urine


Renal Transplantation

One of the early Boston recipients of a kidney transplant from an identical twin, shown here with her twin sister and their children.

Types of graft rejection

Hyperacute
Immediate graft destruction due to ABO or pre-formed anti-HLA antibodies.
Characterised by intravascular thrombosis
Acute
Occurs during the first 6 months
T-cell dependent, characterised by mononuclear cell infiltration
Usually reversible

Chronic

Occurs after the first 6 months
Characterised by myo-intimal proliferation in graft arteries leading to ischaemia and fibrosis

Patient selection

Renal transplantation is the preferred treatment for many patients with end-stage renal disease because it provides a better quality of life than dialysis.

Evaluation of potential recipients for organ transplantation

Determine presence of comorbidity
Exclude malignancy and systemic sepsis
Evaluate against organ-specific criteria for transplantation


Causes of allograft dysfunction
Early
Primary non-function (irreversible ischaemic damage)
Delayed function (reversible ischaemic injury)
Hyperacute and acute rejection
Arterial or venous thrombosis of the graft vessels
Drug toxicity (e.g. calcineurin toxicity)
Infection (e.g. CMV disease in the graft)
Mechanical obstruction (ureter/common bile duct

Late

Chronic rejection
Arterial stenosis
Recurrence of original disease in the graft (glomerulonephritis, hepatitis C)
Mechanical obstruction (ureter,common bile duct)

Immunosuppressive agents

Corticosteroids :
Widespread anti-inflammatory effects.
Azathioprine:
Prevents lymphocyte Proliferation.
Ciclosporin:
Blocks IL-2 gene transcription

Thank you foryour attention