Clinical Observation on Urethral Injury

Hwang, Tae Gon; Chun, Choong Sung

Abstract

In order to study the method of management of urethral injury, the clinical observation was made on the 81 cases of urethral injury who were treated at Department of Urology, Catholic Medical College, during the period from Jan. 1970 to Dec. 1980. The results were as follows: 1. In age distribution of the 81 cases of urethral injury, age of 59 cases ranged from 10 to 39 years. The main causes of urethral injury were traffic accident (46. 9%) and industrial accident (28. 4%). 2. The symptoms of urethral injury were urethral bleeding (61 cases, 75. 3%), acute urinary retention (26 cases, 32. 1%), inability to void(12 cases, 14.8%) and others. The associated injuries of the urethral injury were pubic bone fracture (45 cases, 55.6%), bladder rupture (8 cases. 9.9%), renal injury (2 cases. 2.5%) and others. 3. Among 69 cases of urethral injury in whom urethrography were performed, two cases (2.9%) had injury in the penile urethra, 22 (31. 9%) in the bulbar and 45 (66.2%) in the posterior. twenty four (34. 8%) had partial injury and 45 (65. 2%) complete. 4. Initial managements of urethral injury consisted of indwelling catheter (11 cases, 13. 6%), primary realignment with interlocking sound (40 cases, 49.4%), urethral anastomosis (5 cases, 6.2%) and suprapubic cystostomy (25 cases, 30. 9%). 5. Of the 11 cases of retaining catheter, no complication was noticed, while among the 40 cases of primary realignment with interlocking sound, the complications were urethral stricture (6 cases). urethral fistula (2 cases), wound infection (2 cases), incontinence (1 case) and bladder stone (1 case). Of the 5 cases having urethral anastomosis, a case developed urethral fistula. Of the 25 cases having suprapubic cystostomy, 7 (28%) were successfully treated only with cystostomy Two to five months after cystostomy. 18 cases having residual urethral stricture urethroplasty, were performed and the complications were urethral fistula (1 case), impotence (1 case) and incontinence (1 case). In urethral injury, the definitive diagnosis must be made by urethrography and the initial management which must be provided is catheterization without excessive force. If catheterization fails, the suprapubic cystostomy is the best alternative management, the definitive urethroplasty have to be followed 3 to 6 months later which remained urethral stricture.