Testis Urethra Trauma 2

11.3 Rupture Of The Membranous Urethra

      Intrapelvic rupture of the urethra occurs in the membranous portion near the apex of the prostate, usually as a result of a fracture of the pelvis.

11.3.1 CLINICAL FEATURES

      Most commonly, this injury occurs in road traffic accident; crush injuries and falls, there may be in addition, injury to the head, thorax, abdomen or fracture of the long bones.

      The patients are in a state of shock from blood loss and may be unconscious. Careful assessment of the whold patient must be undertaken. There may be blood at the external urinary meatus associated with no passage of urine, the bladder may be palpable.

      If there is an intra-peritoneal ruputre of the bladder, signs of peritonitis will soon develop, but if the rupture is extraperitoneal, the diagnosis is often more difficult .

      With extraperitoneal rupture of the bladder, there is some suprapubic tenderness and perhaps a little dullness to percussion.

11.3.2 TREATMENT

      Blood loss and shock are treated aggressively, antibiotics are given.

      A suprapubic cystostomy should be performed and the bladder drained in this way.

      Endoscopy is done three weeks after the injury.

      An open procedure to re-establish continuity and the placement of a urethral catheter is advocated.

      If the prostate is floating, the rupture is complete. The older classical method-railroading a catheter across the gap is attempted.

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