Campos-Salcedo JG, Hernández-Martínez G, Terrazas-Ríos JL, Sedano-Lozano A, Castro-Marín M, Flores-Terrazas JE, López-Silvestre JC, Zapata-Villalba MA, Mendoza-Álvarez LA, Estrada-Carrasco CE, Paredes-Calva C, Rosas-Hernández H

Language: Spanish
References: 7
Page: 113-118
PDF size: 390.61 Kb.

ABSTRACT

Pelvic fractures are the main cause of posterior urethral trauma and they occur in men (10%) and women (6%). Urinary incontinence, erectile dysfunction, and urethral stricture are the principal complications. Cystotomy is the initial treatment and the criterion standard is late reconstruction in total urethral disruption three months after injury. However, a case of early repair due to associated orthopedic injuries is presented herein. The aim of this article is to describe the early treatment of injuries to the posterior urethra as a new treatment option.
A 21-year-old man was brought to the hospital for injuries received in an automobile accident in which he had been thrown from the vehicle. He presented with a fractured pelvis and clavicle, as well as craniofacial fractures. The patient was initially treated by the Urology Service with realignment and transurethral catheterization (TUC). He then underwent osteosynthesis of the pelvic fracture, and disruption of the posterior urethra was identified for which single-layer primary repair with TUC for four weeks was performed. The patient had satisfactory progression in the postoperative evaluation, with no evidence of stricture in studies using a contrast agent, and is currently asymptomatic, continent, and his sexual function has been preserved.
Approach and management include suspicion and adequate physical examination, external urinary diversion, and primary closure delayed for 12 weeks, which is considered “standard treatment”. Today, early primary repair has been a topic of discussion and is associated with higher success rates. The urologist must be skilled in the techniques of approach and primary repair so that complications and sequelae are prevented in these patients.

REFERENCES

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