Viva Questions – Emergency 1, March 2013 – Ivo Dukic, Arie Parnham, Mr Jones
2) WHAT ARE THE IMPLICATIONS OF A POSTER IOR URETHRAL INJURY?
98% caused of traumatic posterior urethral injuries are caused by pelvic fractures. Pelvic
fractures occur as a result of RTA (70%) and 25% fall from height. Patients may have coexistent
bladder injury (10-20%)
Sphincter mechanism may be damaged, continence depends upon the bladder neck
Aims of management are to restore continuity, preserve continence and erectile function. The female
urethra rarely injured - except by contusion (conservative management) or laceration by bone fragments
which usually needs primary open repair
Early repair – poor results and may compromise already unwell patient further
Primary realignment or endoscopic primary realignment – Poor results –should only be performed in
stable patients undergoing other procedures (Bladder neck, prostate and rectal injuries). Complications
include a high stricture rate 70%, incontinence 20% and erectile dysfunction 44%.
Delayed urethroplasty repair
SPC catheter insertion
o
Up and downagrams at 6 weeks
o
Assess bladder neck (Flexi down SPC tract or cystogram)
Repair at 3 months with bulbo-prostatic anastamotic urethroplasty
Complex surgery, performed at specialist units only
If defect > 2cm need lengthening procedure (can get up to an extra 6cm)
- Inferior pubectomy
- Develop intercrural space (split corpora cavernosa and shorten route to base of penis)
- Re-route urethra around corpora
Re-stricture
ED
Incontinence
60.2%
35.3%
5.2%
10-15% at 10 yrs
19%
(5% as a result of
surgery)
4%
Primary realigment
Delayed Repair
EAU Guidelines, Urological Trauma 2012
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