A 32-years old man with pelvic fracture is in urinary retention with blood at the external urinary means. Retrograde urethrogram shows prostatomembranous disruption. The most appropriate immediate treatment is:
Posterior Urethral injury- Posterior urethra is located in the pelvis and is fixed.- In cases of pelvic fracture- posterior urethra is more prone for injury.- Most common site of injury - bulbomembranous junction. Bulbar Urethral Injury Membranous Urethral Injury More common Less common Direct blow to the perineum (Straddle Injury) Blunt pelvic trauma with fracture pelvis Retention of urine Retention of urine Blood at urethral meatus Blood at urethral meatus Perineal hematoma Pelvic Hematoma Normal prostate High Lying prostate Superficial extravasation Deep extravasation - Gold standard Treatment for suspection of Urethral injuries- Suprapubic cystostomy - Delayed repair can be done after 3 months.- In emergency, surgical repair should not be attempted due to increased risk of stricture and incontinence.- Repeated urethral catheterization can conve paial tear to complete tear.
Urethral catheterization
Exploration and repair of urethra
Suprapubic cystostomy
Perineal urethrostomy
Urethra and penis