Case 8

• 14 yr old male , a student, resident of Eluru .

• c/o Inability to pass urine per urethra since 6 months following
a RTA .
• H/o blunt trauma to abdomen due to fall of a tractor on the
body about 6 months back followed by inability to pass urine
associated with pain in the abdomen and blood at the urethral
meatus noted then patient underwent emergency exploratory
laparotomy i/v/o haemoperitineum – pelvic haemostasis
achieved and open spc done with posterior urethral repair .
• H/o both lower limb numbness + and diagnosed as
demyelinating sensory polyneuropathy and treated
conservatively
• H/o pelvic fracture present and treated conservatively with
pelvic binder
• H/o blood transfusion +
• Not able to walk for 4 month after RTA ,now walking with
support
• He is on SPC since then, changed periodically.
• No h/o fever, pyuria, hematuria, scrotal swelling and
discharge from perineum.
• No h/o of renal trauma
•
History
No h/o altered bowel habits.

• No h/o lower limb weakness.

• Penile erections and sensations – present

• ( No ejaculation on masturbation )

• No h/o comorbidities

• No h/o any urinary complaints before accident

• No h/o previous surgery

 History

•Unmarried

•He takes mixed diet.

•Bowel habits- normal

•Smoker and alcoholic .

 General Examination
• Moderately built and moderately nourished.

• No Anemia, jaundice, cyanosis, clubbing, pedal edema, Generalised

lymphadenopathy.

• Spine- normal

• Gait : limping gait

• Patient is able to squat and can be kept in lithotomy position.

• BP : 130/70 mmHg

• PR : 82/min

• Temp : afebrile
 Local Examination
• External genitalia : Uncircumcised Penis, local hygiene well maintained

• Glans pink, warm and sensations intact, no BXO changes

• External urethral meatus - normal.

• Urethra- soft and supple

• Scrotum- B/L Testes, Spermatic cord - normal

• Perineum - healthy, no scars, no fistula , normal sensation.

• P/A : Soft, no organomegaly, 16 Fr foleys as SPC in-situ ,draining clear urine

• DRE – Normal, BCR+, Anal Tone - Normal, Prostate – Normal location

 Systemic examination

• CNS : No focal neurological deficit.

• Spine : Normal

• CVS : S1 S2 heard.

• Lungs : Clear.
 Investigations
• Hb : 10.1 gm/dl

• BGT – O Positive

• RBS : 117 mg/dl

• S. Creatinine : 0.9 mg/dl

• B. Urea : 31 mg/dl

• Viral Screening - Negative

• LFT & Sr. Electrolytes – With in Normal Limits

 Other Investigations
• Urine examination

1-2 pus cells+

Alb –Nil

Sugar – Nil,

No Crystals

• Urine Culture – No Bacterial Growth

X-ray pelvis AP view
Retrograde Urethrogram
MCUG
Up & Down urethrogram
Post void
USG ABDOMEN AND PELVIS
 Ultrasound abdomen

• Both kidneys normal in size and echotexture.

• Urinary bladder distended with Suprapubic catheter in-situ.

• Liver normal in size and echotexture.