1. MALE URETHRAL INJURY Prepared by : ABDULLAH BA-FADHEL
Supervisor : Dr. MOHAMMED LAHDAN

2. ANATOMY The adult male urethra is about 18cm – 25cm long.
Posterior urethra:
Prostatic urethra
Membranous urethra
Anterior urethra:
Bulbous urethra
Pendulous urethra
Fossa navicularis
(penile urethra)

3. ANATOMY Fascial planes of the genitalia and perineum.
Buck’s fascia (deep fascia of the penis)
Colles’ fascia (superficial fascia of perineum)
Scarpa’s fascia

4. CLASSIFICATION
Posterior urethral injury (above the urogenital diaphragm)

5. CLASSIFICATION
Anterior urethral injury (below the urogenital diaphragm)

6. AETIOLOGY POSTERIOR INJURY : ANTERIOR INJURY :
PELVIC FRACTURE (mainly)
IATROGENIC
ANTERIOR INJURY :
BLUNT :
Falling astride
Perineal trauma
PENETRATING (mainly)

7. DIAGNOSIS CLINICAL: The triad of urethral disruption
History of trauma
Haematuria
Inability to voide
Blood at the meatus
“Butterfly” ecchymosis
Upward displacement of the prostate by per rectal examination
The triad of urethral disruption
Blood at the urethral meatus
Inability to urinate
Palpably full bladder

8. DIAGNOSIS RADIOLOGICAL: By retrograde urethrography
Normal retrograde urethrogram

9. Retrograde urethrogram reveals a type I urethral injury with minimal stretching and slight luminal irregularity of the posterior urethra. No extravasation of contrast material is present.

10. Retrograde urethrogram demonstrates a less common type II urethral disruption. Extravasation of contrast material (solid arrow) from the posterior urethra is seen proximal to an intact urogenital diaphragm (dashed arrow).

11. Retrograde urethrogram reveals a type III urethral tear at the urogenital diaphragm (solid arrow) and a type IV urethral disruption at the bladder neck (dashed arrow).

12. Retrograde urethrogram shows a type V urethral injury with extravasation of contrast material from the distal bulbous urethra.

13. MANAGEMENT POSTERIOR INJURY ABC Suprapubic cystostomy
Primary realignment
With an antegrade urethral catheter
In stable patient
Acutely or within several days of injury
Immediate suture reconstraction is not recommended

14. MANAGEMENT Delayed reconstruction: Endoscopic reconstruction:
At 3 months scar tissue at the urethral disruption site is stable enough to allow posterior urethroplasty to be undertaken safely.
Endoscopic reconstruction:
Cut-to-the-light procedure
Core-through procedure
Open surgery reconstruction:
Perineal anastomotic approach
A combined abdominoperineal approach

16. MANAGEMENT ANTERIOR INJURY: 1. Blunt trauma Suprapubic cystostomy
Contusion
Incomplete
disruption
Complete disruption
Suprapubic cystostomy
Immediate exploration and direct repair is the treatment of choise
Can be treated with urethral catheter diversion alone

17. MANAGEMENT 2. PENETRATING INJURY : Immediate repair must be tried
Careful debridement to excise all the devitalised tissue should be done
Up to 2 cm of the bulbous urethra and 1.5 cm of the penile urethra can be repaired
If more tissue is lost delayed repair is advised

19. COMPLECATION INCONTINANCE IMPOTANCE URETHRAL STRICTURE
URETHRAL FISTULA
PERIURETHRAL ABSCESS

20. Thank you for your attention