Mateos-Chavolla JP, Zuviri-González A, Guzmán-Hernández F, Alias-Melgar A, Catalán-Quinto G, Cortez-Betancourt R

Language: Spanish
References: 13
Page: 225-229
PDF size: 463.42 Kb.

ABSTRACT

In general, injuries with urethral rupture occur in combination with polytraumatisms from automobile accidents, falls, or industrial accidents. Pubic diastasis, pubic rami fractures, or more complex pelvic fractures can be associated with urethral rupture. Posterior urethral trauma management is complex and requires extensive knowledge of anatomy and reconstructive techniques.
Patient is a 36-year-old man whose illness began eight hours prior to hospital admittance. Walking along the street he fell one and a half meters astride a metallic cylindrical structure. He presented with volume increase and persistent pain in the perineal and scrotal region that increased when walking and he had important mobility arch reduction in inferior members. Penile base had purplish coloring, scrotum was edematous, testes had normal appearance and were not painful when palpated, and there was perineal ecchymosis extending to inguinoscrotal region with “butterfly” image. Rectal examination revealed high prostate that was partially palpable, mobile, and painful. Laboratory studies were done as well as scrotal ultrasound and urethrocystography that identified posterior urethral injury together with pubic diastasis, sacroiliac articulation luxation, and coccygeal fracture. Surgical exploration revealed approximate 700 mL urinoma in retropubic space, pubic symphysis diastasis, bladder injury with approximate 1.5 cm tear in transverse neck, laceration in anterior wall of prostatic urethra, and pelvic wall injury with corpora cavernosa exposure. Bladder neck injury and injury to anterior wall of prostatic urethra were repaired with 0 chromic catgut with hemostatic sutures on the Santorini plexus. Anterograde 18 F Foley transurethral catheter was placed and cystostomy with 20 F Foley catheter was carried out.

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