Features of treatment of posterior urethral injuries in the acute period of traumatic disease

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BACKGROUND: Combined pelvic trauma in men in 10%–24% of cases is accompanied by damage to the posterior urethra, and no consensus on the treatment tactics has been established for such patients.

AIM: This study aimed to evaluate the results of treatment of patients with closed injury of the posterior urethra and traumatic shock.

MATERIALS AND METHODS: A retrospective analysis of the results of treatment of 46 patients with closed injury of the posterior urethra caused by a fracture of the pelvic bones and traumatic shock was performed. The average age of patients was 42.1 ± 9.9 years. The severity of urethral injuries was assessed according to the American Association for the Surgery of Trauma (AAST) classification.

RESULTS: The choice of treatment techniques depended on the degree of damage to the urethra and severity of traumatic shock. Upon hospital admission, 15 (32.6%) patients were diagnosed with grade I, 21 (45.6%) with grade II, and 10 (21.7%) with grade III traumatic shock. In grade I–II traumatic shock patients with incomplete urethral rupture, a urethral catheter was inserted, followed by conservative therapy. If a catheter insertion was possible, a retropubic revision of the urethra was performed. Patients with grade III–V urethral injury according to AAST and grade I–II traumatic shock underwent primary or delayed urethroplasty, such as urethral suturing and urethra-urethral anastomosis. Patients with grade III traumatic shock had a urethral catheter or cystostomy. In the long-term, 6 of 17 (36.9%) patients who underwent primary or delayed urethroplasty had short-term (up to 5 mm) urethral strictures, for which optical urethrotomy was performed. All patients with complete urethral avulsion who did not undergo early urethroplasty developed 10–20 mm strictures, requiring reconstructive surgery.

CONCLUSIONS: The choice of treatment techniques for patients with concomitant damage to the posterior urethra depends on the degree of damage to the urethra and severity of traumatic shock. The scope of treatment in the acute period may include urethral or suprapubic drainage of the bladder or reconstructive surgery.

作者简介

Gocha Shanava

I.I. Dzhanelidze Research Institute of Emergency Medicine; Almazov National Medical Research Centre

编辑信件的主要联系方式.
Email: dr.shanavag@mail.ru
SPIN 代码: 1706-7410

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Alexey Sivakov

I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: alexei-sivakov@mail.ru
SPIN 代码: 3064-8134

MD, Cand. Sci. (Medicine), Associate Professor

俄罗斯联邦, Saint Petersburg

Arutyun Movsisyan

I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: movs@mail.ru
SPIN 代码: 2305-0087

MD

俄罗斯联邦, Saint Petersburg

Georgii Shanava

Academician I.P. Pavlov First Saint Petersburg State Medical University

Email: baset.hunter@mail.ru
俄罗斯联邦, Saint Petersburg

参考

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2. Fig. 1. Anastomotic urethroplasty in avulsion of the posterior urethra: a, catheterization of the urinary bladder, suturing the membranous and prostatic parts of the urethra; b, anastomotic urethroplasty of the posterior urethra

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3. Fig. 2. Urethrography. Extravasation of contrast agent in the membranous urethra

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4. Fig. 3. Computed tomography combined with urethrography. Extravasation of contrast agent in the membranous urethra

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5. Fig. 4. Complete avulsion of the membranous urethra. A Foley catheter (white arrow) in distal part of the injured urethra. Forceps are inserted into the cavity of the bladder (black arrow)

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