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Urology
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
An absolute contraindication is urethral trauma. This should be suspected in cases of pelvic injury or in any trauma case. The ATLS protocol should be followed in a trauma call. This would involve fully exposing the patient and examining the perineum, genitals and performing a digital rectal examination. Blood found at the urethral meatus, scrotal haematoma or a high-riding prostate should all raise alarm about a possible urethral tear. A retrograde urethrography should be performed in such cases to rule out any urethral injury.
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 23 year old builder is seen in the emergency department following a fall from scaffolding. CT chest abdomen pelvis demonstrates several right rib fractures and a small amount of free fluid in the pelvis. The patient has haematuria and blood at the urethral meatus. The urology team request retrograde urethrography. This demonstrates extravasation of contrast into the retropubic space, but continuity of the urethra is maintained.
Urinary system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
For imaging of the male urethra, conventional radiographic contrast studies including retrograde urethrography (RUG) are most commonly utilised. These are best suited for delineating luminal problems of the urethra and for this reason are commonly used as the primary imaging modality for patients with various urethral abnormalities such as trauma, inflammation and stricture. Urethrography is the term applied to the radiographic examination of the male urethra using a water-soluble iodine contrast agent. RUG is excellent in evaluating urethral luminal abnormalities. RUG and voiding cystourethrography (VCUG) can be performed independently but to visualise the entire urethra, both should be performed as RUG provides superior imaging of the anterior urethra, whereas VCUG is often preferred for the evaluation of the posterior urethra.
Syringocele: a retrospective study and review of the literature
Published in Scandinavian Journal of Urology, 2019
Frederikke Eichner Sørensen, Martin Skott, Yazan F. Rawashdeh, Hans Jørgen Kirkeby
The adult patients presented with more various symptoms than the children. Five of the 11 adult patients presented with obstructive voiding symptoms, five presented with perineal pain or dysuria, three presented with urethral discharge or post-void dribbling and two presented with UTI. Diagnostic testing in the adult patients was seen to be more inconsistent. Uroflowmetry was performed in 45% of the adult patients, 45% underwent a MRI, and only 27% underwent a retrograde urethrography and interestingly none of the adults had a VCUG done. Two of the 11 adult patients were managed conservatively due to the proximity of the syringocele to the external urinary sphincter. They received instructions on post-void compression of the urethra to minimize post-void dribbling. Nine of the adult patients underwent endoscopic marsupialization. In the children the procedure was performed with a cold knife and in the adults the marsupialization was performed with a monopolar knife (Collin’s knife) (Figure 2). None of the patients developed post-operative urethral stricture. Three of the adult patients were lost to follow-up. One adult patient had persisting symptoms with pain and urinary incontinence. He was re-operated on with closure of the bladder neck and diverted by vesico-appendico-cutaneostomy [9]. Eighty-six per cent of the adult patients had minimal to no symptoms after the treatment.
Post-transcriptional suppression of TIMP-1 in epithelial-differentiated adipose-derived stem cells seeded bladder acellular matrix grafts reduces urethral scar formation
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2018
Yinglong Sa, Lin Wang, Huiquan Shu, Jie Gu
New Zealand white male rabbits (1.5–2.0 kg; SLAC Laboratory Animal, Shanghai, China) were used in the current study. The rabbits were randomly divided into different experimental groups, and each containing 10 animals. All surgeries were performed by the same surgeon, according to a published protocol [18]. Briefly, a ventral urethral mucosal defect (VUMD) with a mean length of 2.0 cm and mean width of 0.8 cm was created in the rabbit penile urethra about 2.0 cm from the external urethral orifice. The grafts seeded bladder acellular matrix grafts (BAMG) was placed over the urethral mucosal defect using 6–0 vicryl sutures (Ethicon, Somerville, NJ). A urethral catheter was placed for 14 days to provide bladder drainage after the surgery. Retrograde urethrography and histology analysis were done 5 months after surgery.
Lower urinary tract injuries in patients with pelvic fractures at a level 1 trauma center – an 11-year experience
Published in Scandinavian Journal of Urology, 2023
Lasse Rehné Jensen, Andreas Røder, Emma Possfelt-Møller, Upender Martin Singh, Mikael Aagaard, Allan Evald Nielsen, Lars Bo Svendsen, Luit Penninga
There are several issues related to diagnosis and management of urethral injury. Clinically, urethral injury is suspected if bloody discharge is observed at the meatus, or if urethral catheter placement is difficult or even impossible. However, partial ruptures may never be recognized in the heat of the trauma, and the true incidence of urethral injury may be underreported. On the other hand, unrecognized partial urethral ruptures may be of little clinical relevance both short- and long-term. It remains unknown if a clinically suspected urethral injury should be radiologically confirmed if placement of catheter is uncomplicated. Retrograde urethrography remains the gold diagnostic standard and is recommended by both European and American guidelines [16,19]. Only 5% of patients in this cohort underwent retrograde urethrography in the initial phase which may have impaired correct classification of the urethral injury. Also, precise anatomical classification of the injury was not always possible. Primary realignment is still recommended as best initial management and was achieved in 45% of cases here with CAD. We observed a use of combined SPC and CAD in patients with partial injury, but unfortunately the clinical indication was not clear and there is no literature to support this strategy. In patients with complete rupture and floating prostate, SPC was the primary treatment with secondary realignment. In cases where early re-alignment is suitable, endoscopic re-alignment is preferred, but in complete ruptures, the aim of re-alignment is to correct severe distraction injuries rather than to prevent stricture [16,17,20]. Three large systematic reviews showed an advantage of endoscopic re-alignment according to observational data [17,21,22]. When endoscopic re-alignment is possible, stricture formation is reduced to 44–49% compared to 89–94% stricture rate with suprapubic diversion. Furthermore, early re-alignment does not increase the risk of urinary incontinence or ED [17,21,22]. Several factors such as patient selection: severe vs. milder trauma and partial vs. complete ruptures, and differences in follow-up duration complicates comparison with other techniques, especially urethroplasty. These differences could also explain discrepancies in rates of incontinence, ED and re-stricture [17]. According to EAU guidelines, treatment of complete ruptures remains SPC with deferred urethroplasty, which ensures time for treatment of associated injuries, but also for pelvic hematoma resolution, prostate descend, and for scar tissue and patient to stabilize [23]. Deferred urethroplasty has an overall success rate of 86%, a low rate of incontinence (approximately 5%), and does not significantly affect erectile function itself [24,25].