Endoscopic Management of Penetrating Urethral Injury After an Animal Attack

Primary anastomosis for complete bulbar urethral rupture with rectal laceration caused by straddle injury: A case report

•

About 10% of traumatic injury patients have genitourinary involvement.

•

Immediate exploration and urethral reconstruction is indicated in urethral trauma.

•

Urethra rupture with anorectal laceration can be treated with primary anastomosis.

Introduction

The initial management of urethral trauma remains disputed, and there are several suitable techniques, including delayed repair and suprapubic urinary diversion as well as primary endoscopic or open alignments. The treatment choice used depends on the rupture’s location and length as well as the accompanying trauma.

Case presentation

A 33-year-old male patient was referred to the department of emergency, with the chief complaint of inability to void experienced 1 day before being admitted, after falling from a height of approximately three meters. There was a laceration to the perineum 3 cm long to the rectum, with no active bleeding. After the incident, the patient could not void, but the lower abdomen was not painful. Upon retrograde urethrography examination, contrast extravasation of the bulbous urethra was seen through the anorectal laceration. Immediate debridement and repair for the anorectal wound, then primary anastomosis for the bulbous urethra, was performed.

Discussion

The likelihood of an injury to the anterior urethra increases with certain clinical features, including blood in the urethral meatus, palpable bladder distention, and a butterfly appearance on the perineum. Immediate exploration and reconstruction of the urethra is recommended in urethral traumas associated with penile fractures and non-life-threatening penetrating injuries. Furthermore, small lacerations are repaired primarily, while total ruptures are treated with anastomosis.

Conclusion

Proper identification and management of urethral rupture determines the outcome. Initial urethral trauma management is disputed; however, a bulbous urethra rupture with anorectal lacerations can be treated safely and effectively with primary anastomosis.

Different Techniques for Management of Problematic Urethral Catheterization in Male Children

Background: Urethral catheterization is very common, considered a minor procedure done by physicians and well-trained nurses. However, in some traumatic or congenital cases, male catheterization is problematic. A multitude of techniques are available and still can utilize the natural urethral opening to manage this distressing situation. Among these techniques, cystoscopic-assisted retrograde catheterization and railroad techniques are reliable options. This article aimed to document application and to evaluate outcomes of both techniques for problematic male urethral catheterization. Patients and Methods: In our hospitals from February 2015 to March 2020, 167 boys with problematic urethral catheterization underwent cystoscopic-assisted catheterization technique over a guidewire and 6 cases underwent railroad technique due to failed cystoscopic-assisted technique. Both techniques were done under general anesthesia with the patient in supine position and their details will be presented later on. Results: Patients' mean age was 7.2 ± 2.9 years (range = 2-14). One hundred sixty-seven cases (96.5%) underwent cystoscopic-assisted catheterization, while only 6 cases (3.5%) were managed by railroad technique. For cystoscopic-assisted technique, mean operative time was 4 ± 1.5 minutes (range = 6-18). Mean follow-up period was 54 ± 1 months (range 6-60) with only 1 case developed urethral stricture. For the railroad technique, operative time was 7.5 ± 2.6 minutes (range = 10-34), mean follow-up was 45 ± 3 months with 3 cases developed vesicocutaneous fistula, and 4 cases developed residual urethral stricture. Conclusion: Cystoscopic-assisted retrograde catheterization is a minimally invasive, safe, and reliable technique to catheterize the exceptionally difficult male urethra.