RUPTUR URETRA

Andharu Primayudha Infantri

G1A214002

Pembimbing : dr. Hendra Herman, Sp.U

About 10% of all injuries seen in the emergency room

involve the genitourinary system to some extent.
Fractures of the lower ribs are often associated with
renal injuries, and pelvic fractures often accompany
bladder and urethral injuries.
Urethral injuries are uncommon and occur most often
in men, usually associated with pelvic fractures or
straddle- type falls.
Early diagnosis is essential to prevent serious
complications.

The urethra can be separated into 2 broad anatomic

divisions:
the posterior urethra : consisting of the prostatic
and membranous portions
the anterior urethra : consisting of the bulbous and
pendulous portions.

INJURIES TO THE
POSTERIOR URETHRA
When pelvic fractures occur from
blunt trauma, the membranous
urethra is sheared from the
prostatic apex at the
prostatomembranous junction.

The American Asosiasi for Surgery Trauma (AAST)

Sign and Symptoms

Blood at the urethral meatus
Suprapubic tenderness
Inability to urinate
lower abdominal pain
A history of crushing injury to the pelvis
The presence of pelvic fracture are noted on physical
examination
A large developing pelvic hematoma may be
palpated

X-RAY FINDINGS
A urethrogram (using 2030 mL of water-soluble
contrast material) shows the site of extravasation at
the prostatomembranous junction.

Treatment
EMERGENCY MEASURES :
Shock and hemorrhage should be treated.

SURGICAL MEASURES :
1. Immediate management
2. Delayed urethral reconstruction
3. Immediate urethral realignment

1. Immediate management
Initial management should consist of suprapubic
cystostomy to provide urinary drainage.
The suprapubic cystostomy is maintained in place
for about 3 months.
incomplete laceration of the posterior urethra
heals spontaneously, and the suprapubic
cystostomy can be removed within 23 weeks.
The cystostomy tube should not be removed
before voiding cystourethrography shows that no
extravasation persists.

2. Delayed urethral reconstruction

Reconstruction of the urethra after prostatic disruption can
be undertaken within 3 months, assuming there is no pelvic
abscess or other evidence of persistent pelvic infection.
The pre ferred approach is a single-stage reconstruction of
the urethral rupture defect with direct excision of the
strictured area and anastomosis of the bulbous urethra
directly to the apex of the prostate.
A 16F silicone urethral catheter should be left in place
along with a suprapubic cystostomy. Catheters are removed
within a month, and the patient is then able to void

3. Immediate urethral realignment

Persistent bleeding and surrounding hematoma
create technical problems.
The incidence of stricture, impotence, and
incontinence appears to be higher than with
immediate cystostomy and delayed reconstruction.

Complications
Stricture
Impotent
Incontinence

INJURIES TO THE ANTERIOR

URETHRA

Classification based on
radiology
Contusio
Incomplete disruption
Complete disruption

Pathogenesis &
Pathology
A. CONTUSION
Contusion of the urethra is a sign of crush injury without
urethral disruption. Perineal hematoma usually resolves
without complications.
B. LACERATION
A severe straddle injury may result in laceration of part
of the urethral wall, allowing extravasation of urine. If
the extravasation is unrecognized, it may extend into
the scro- tum, along the penile shaft, and up to the
abdominal wall. It is limited only by Colles fascia and
often results in sep- sis, infection, and serious morbidity.

Sign and Simptoms

There is usually a history of a fall, and in some
cases a his- tory of instrumentation.
Bleeding from the urethra
There is local pain into the perineum and
sometimes massive perineal hematoma.
If voiding has occurred and extravasation is noted,
sudden swelling in the area will be present.

X-RAY FINDINGS
A urethrogram, with instillation of 1520 mL of
water-sol- uble contrast material, demonstrates
extravasation and the location of injury. A contused
urethra shows no evidence of extravasation.

Treatment
1. Urethral contusion
The patient with urethral contusion shows no
evidence of extravasation, and the urethra remains
intact. After urethrography, the patient is allowed to
void; and if the voiding occurs normally, without pain
or bleeding, no additional treatment is necessary. If
bleeding persists, urethral catheter drainage can be
done.

2. Urethral lacerations
suprapubic cystostomy tube can be inserted,
allowing complete urinary diversion while the urethral
laceration heals.
If only minor extravasation is noted on the
urethrogram, a voiding study can be performed within
7 days after suprapubic catheter drainage to search
for extravasation
Healing at the site of injury may result in stricture
formation

Daftar Pustaka
Blair, Meg. 2011. Overview of genitourinary trauma. Diakses pada mei 2015. Diunduh dari
URL: http://www.medscape.com/viewarticle/746075
Purnomo, Basuki B. 2003. Dasar-dasar urologi. Edisi 3. Jakarta : Sagung Seto
Schenkman, Noah S. 2013. Male Urethra Anatomy. Diakses pada mei 2015. Diunduh dari URL:
http://emedicine.medscape.com/article/1972482-overview#showall
Snell, Richard S. 2006. Anatomi klinik untuk mahasiswa kedokteran. Ed. 6. EGC: Jakarta
Hansen, John T. 2005. Netters clinical anatomy. 2nd Edition. Philadelpia : Elseivers Sanders
Pineiro, L. Martinez. 2007. Urethral trauma. Diakses pada mei 2015. Diunduh dari URL:
http://www.springer.com/978-3-540-48603-9.pdf
Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell-walsh urology. 9 th Edition.
Philadelphia : Saunders elsevier; 2007
Cummings, James M. 2013. Urethral trauma. Diakses pada mei 2015. Diunduh dari URL:
http://emedicine.medscape.com/ article/451797-workup#showall
Pineiro LM, Djakov M, Plas E, et al. 2010. EAU guidelines on urethral trauma. European Urology
57 (2010) 79-803.
Rosenstein, Daniel I, Alsikafi NF. 2006. Diagnosis and clasification of uretrhal injuries. Urologic
Clinic of North America. 33 (2006) 73-85.
Sjamsuhidayat R, Jong W. 2005. Buku ajar ilmu bedah. Ed.2. EGC: Jakarta.

TERIMA KASIH