1. Male urethral injuries bladder injury
Dr,mohamed fawzi alshahwani

3. Urethral injury divided into
Anterior Urethral injury
posterior Urethral injury

6. Anterior urethral injury bulbar urethral injury
Causes
blow to the perineum
Stradal injury: cycling,loose manhole covers

7. Clinical features
Suspect urethral injury after blunt perineal trauma when;
The man goes into retention
There is perineal swelling butterfly hematoma
Theres blood at urethral meatus

9. Accordingly the injury can be divided into
Treatment
Once urethral injury is suspected
Dont allaw the patient to urinate
Dont insert a foleys cathter
unless after doing
retrograd urethrography
Accordingly the injury can be divided into

10. the dye pass to bladder ,no exravasation 2,Partial rupture
Contusion
the dye pass to bladder ,no exravasation
2,Partial rupture
the dye pass to bladder ,with exravasation
3,Compleate rupture
the dye did not pass to bladder ,with exravasation

12. Retrograde ureththrography showAntrior partial urethral injury

13. Treatment Contusion analgesic and antibiotic
Partial and compleat rupture
suprapubic cystostomy
after 3 weeks retrograde urethrography done to asses the urethra,usually there will be a stricture which should be treated by
dilatation,or urethrotomy,or urethroplasty

14. Posterior urethral injyry membranous urethral injury
Intra pelvic rupture of membranous urethra occure near the apex of prostate
Most comonlly deu to blunt trauma withe pelvic fracture

15. Posterior urethral injury

16. Clinical picture History or trafic accident,fall
Blood at external urethral meatus
There may be associated injury to head,chest,abdomin,fracture of long bones,which may take priority in management to keep the pationt a live

17. Clinical picture,cont KUB usually there is pubic bone fracture
PR examination
very high prostate, pelvic hematoma
Retrograde urethrography
extravasation of dye

18. Treatment ABC Espicially when there is multiple injury
Suprapubic cystostomy
should be formal type when associated intraperitoneal bladder injury is suspected to repair the bladder at the same time
Some surgion prefer rail roading method to realign the seperated urethral ends
after 6 to 8 weeks asses the uretha by urethrography or urethroscopy

19. Complication of post urethral injury
Urethral stricture
2: urinary incontinence
3; impotence

20. Bladder injuries Causes
Peroperative TURP..TURBT,,cystolitholapaxy,cystoscopic bladder biobsy,caeserean section,
blunt pelvic trauma,
Penitrating trauma

21. Types of perforation Intraperitoneal perforation
the urine escape to the peritoneal cavity
Extraperitoneal perforation
the urine escape into the space around the bladder

22. Diagnosis
If injury occure During endoscopic operation the diagnosis is clear on visual inspiction alone,adark hole or loop of bowel is seen

23. In case of blunt trauma
The classicall symtoms and sign are
suprapubic pain and tenderness
in ability to pass urine
haematuria
these sign and symtoms are indication for retrograde cystography

24. Retrograde cystogram
300 to 400 cc of contrast is ingecteto the bladder and film is takin
then another film post evacuation is takin
In intra peritoneal perforation loop of bowel may be out line by the contrast
In extraperitoneal perforation the cotrast is limitted to immediate area surrounding the bladder

25. Intra peritonial extraperitonial

26. Treatment Extraperitoneal
Blader drainage with a urethral drainage for 2 weeks followed by cystogram to conferm healing of perforation
Indication for surgical repair
1 a bone spike protruding to the bladder
2 associated rectal or vaginal perforation

27. Intraperitoneal
Usuqlly repqired surgicqlly to prevent complications from leakage of urine to the peritoneal cavity