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Urethra and Penis
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Urinary incontinence The site of the urethral rupture is at or close to the striated urethral sphincter. If the external urethral sphincter is damaged or destroyed, continence of urine will depend on the bladder neck mechanism. While this is usually adequate to maintain complete continence (only 5-10% of men suffer stress urinary incontinence after urethroplasty), subsequent surgical manoeuvres that destroy the bladder neck (such as transurethral prostatectomy) may cause incontinence.
Genitourinary Trauma
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
Patrick C. Samson, Jay A. Motola
The timing of the repair of these injuries has been debated and several series have satisfactorily provided evidence-based outcomes. RUG is required to determine a complete or incomplete injury. The most common complication related to these injuries is the subsequent development of a urethral stricture, with a statistically greater likelihood of stricture formation in those who had a complete bulbar urethral rupture [38].
Outcome of anastomotic urethroplasty in traumatic stricture (distraction defect) of posterior urethra in boys
Published in Arab Journal of Urology, 2020
Ghulam Mujtaba Zafar, Sikandar Hayat, Javeria Amin, Fawad Humayun
Traumatic posterior urethral stricture in children is a rare condition, but presents a major surgical challenge to paediatric urologists. Paediatric pelvic fracture after blunt trauma has an incidence of 2.4–4.6%. Of these, only 4.2% are associated with urethral injuries [1]. The mechanism of traumatic posterior urethral injury is unique in which there is complete or partial urethral rupture with separation and malalignment of the two ends, resulting in a distraction defect. While, in true urethral stricture there is continual obliteration of the urethral lumen. Complete urethral disruption and distraction defect is more common in children as compared to adults due to severe displacement of the prostatic urethra off the pelvic floor [2]. Access to the posterior urethra and management of distraction defect in children is difficult for many reasons. Firstly, children have immature pelvic bones and unstable fractures associated with severely displaced prostatic urethras. Secondly, due to relative intra-abdominal position of a child’s bladder there is high incidence of simultaneous bladder neck and sphincter complex injury along with urethral trauma [3]. Lastly, children have smaller pelvic confines, smaller urethral calibre, and greater tissue fragility [4]. Thus, considering all these differences, the management of traumatic posterior urethral strictures in children is more challenging and needs perineal anastomotic urethroplasty in most cases, while a more extensive transpubic approach is needed in some cases with large gaps [2].