Urethral rupture

It is one of the urological emergencies because of another life-threatening

trauma.
Epidemiology
• 10% proportion of trauma cases.
• 4% of the proportion of all urinary tract injuries, especially pelvic
fractures
• Man
Etiology
• Blunt trauma, sharp trauma, Iatrogenic trauma
• 75% of cases of pelvic fractures
• Iatrogenic: instrumental emulation and urethral catheter insertion.
• Sexual behavior, penis fracture.
Clasification

• Anatomy
• Posterior urethra: occurs proximal
to the perineal membrane of the
prostatic urethra or membranous
urethra.
• Anterior Urethra: bulbar and
pendulose urethra to the
navicular fossa.
Patofisiology
• Trauma posterior pelvicuretra posteriorpars mmebranasea or
pars prostatika.
• Fraktur pelvispelvic floor dan sfingter volunteer dan ligament tears
puboprotatik tear the membranous urethra from the prostate apex
hematoma di retropubis dan perivesika.
• Straddle injury Cases Blunt trauma to the perineal region uretra
pas bulosacontusions / lacerations of the urethral wall.
Diagnosis
• Further evaluation: blood in the meatus, penile / perineal hematoma
/ ecchymosis, urinary retention, bladder distension, history of trauma.
• Physical examination: plug rectum (high prostate)
• radiologis uretrografi retrograde( RUG)
Governance
• Stabilization of hemorrhagic shock: fluid resuscitation and dressing
press the bleeding site
• Urinary drainage: suprapubic catheter diversion
Anterior Male Urethral Trauma
• Blunt Trauma
• Sistototomi suprapubic
• Urethroplasty after 3-6 months
• Sharp Trauma
• Immediate surgery: reconstruction and exploration (stable, lacerations, or
stab wounds that require simple wound closure) with anastomosis.
Posterior Urethra Trauma of Men
• Blunt trauma
• Ruptur inkomplit:kateter suprapubic
• Ruptur komplit:realignment, exploration, reconstruction and suprapubic
catheter installation.
• Operational actions are divided into :
• Immediately: <48 hours after trauma
• Primary is postponed: 2 days-2 weeks after trauma
• Postponed:> 3 months after trauma.
• Sharp Trauma
• Eksploration retropubis primary repair, realignment endoskopik,
Female Urethral Trauma
• General impression stabilization
• Retropubic reconstruction surgery for urethra, bladder and pelvic
floor
Prognosis
• Partial urethral rupture with suprapubic catheter placement is of low
stricture risk
• Complete urethral rupture is managed by surgery in the form of
endoscopic realignment or uretroplasty, has a high risk of urethral
stricture.
 Carcinoma prostat
• Second urinary tract malignancies are most commonly seen after
bladder malignancy.
Diagnosis
• History
• Digital rectal examination
• Pathological Anatomy Examination.
• Transrectal Ultrasonography (TRUS).
• Golden standard: biopsy dan Patology Anatomy
Sistem staging for
cancer
AJCC(American Joint
Committee On
Cancer)