Professional Documents
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Bladder Injuries
1. Posterior urethra.
• Prostatic
• Membranous
2. Anterior urethra.
• Bulbous
• Pendolous
prostatic
membranous
bulbar
pendulous
Posterior urethral injuries.
• Posterior urethra injured in 1.6-9.9% of
pelvic fracture.
• Complete: 73%
• Partial: 27%
Causes.
• Shearing force.
• Direct laceration by pelvic bone fragment.
• Distraction,caused by pelvic fracture b/w
pubic symphysis & pubic rami.
Symptoms and Signs
• Blood at the urethral meatus. Do not, do
not, do not try to pass the catheter if it’s
present!!!
• Inability to urinate
• Palpapable bladder
• Pelvic hematoma
• Superiorly dispalced prostate
Diagnosis
• Immediate retrograde
urethrogam.
Posterior urethra laceration
Posterior urethra –complete
tear
Treatment
• Suprapubic cystostomy (Initial treatment)
• Extraperitoneal
– Most common
– Pelvic # in 89-100%
– Bladder rupture in 5-10% of all pelvic #
• Intraperitoneal
– Extravasation of urine in abdomen
– Sudden force to full bladder
– Associated injuries +++ Mortality
(20%)
Clinical Presentation
•McConnel et al. Rupture of the bladder. Urol Clin North Am. 1982.
•Carroll et al. Major bladder trauma: Mechanisms of injury and a
unified method of diagnosis and repair. Journal of Urology. 1984.
• Penetrating injuries: OR
• Blunt
– Intraperitoneal: Almost all OR
– Extraperitoneal: Urethral cath. drainage x 7-
10 days.
Conclusion