Management of Urethral Injuries Secondary to Pelvic Fracture in the Male

Abstract

Objective: To present our experience in the management of urethral injuries secondary to pelvic fracture in the male. Patients and Methods: Between 1979 and 2002, fifty-six male patients (20 children, 36 adults) with urethral injuries secondary to pelvic fracture were managed at the Urology Department, Alexandria Faculty of Medicine, Alexandria, Egypt. Clinical assessment together with retrograde urethrogram was routinely done for each case on admission to the hospital after the accident. The operative findings in the emergency state were recorded to determine the site and extent of the urethral injury. Subsequent combined retrograde urethrography and suprapubic cystography were done to properly evaluate the extent and type of urethral injury. The operative findings during urethral reconstruction and postoperative follow-up were reviewed. Our protocol of management of these cases depended on the type, site and extent of the urethral injury. Results: The urethral injuries encountered in this group of patients included prostate injuries (6 cases, 10.7%), incomplete rupture of the membranous urethra (5 cases, 8.9%), prostato-membranous disruption (22 cases, 39.3%), infra-diaphragmatic urethral injuries (3 cases, 5.4%) and combined urethral injuries (20 cases, 35.7%). Prostate injuries were immediately repaired with good results in all patients. Incomplete rupture of the membranous urethra was managed by suprapubic diversion for three weeks while primary repair was done for two adults with complete disruption. Complete injury of the bulbomembranous urethral junction was encountered in three cases and was managed by immediate repair. Combined urethral injuries of the prostatic and membranous urethra found in three cases were managed by repair of the prostatic injury only, while combined prostato-membranous and bulbo-membranous injuries were managed by suprapubic diversion only. Conclusion: Immediate repair of prostatic injuries should be performed to save the proximal sphincteric mechanism. In cases of prostato¬membranous disruption, only suprapubic urinary diversion should be done, except in very few selective cases. Immediate repair should be tried in some early cases of complete rupture of the bulbomembranous urethra. Primary alignment and vest sutures yielded unsatisfactory results.

African Journal of Urology Vol. 12 (4) 2006: pp. 170-176