Percutaneous antegrade urethral catheterization of the traumatized urethra

Efficacy of urethral catheterisation with a hydrophilic guidewire in patients with urethral trauma for treating acute urinary bladder retention after failed attempt at blind catheterisation

OBJECTIVES

To evaluate the efficacy of urethral catheterisation using a hydrophilic guidewire under fluoroscopic guidance in patients with urethral trauma after a failed attempt at blind catheterisation.

METHODS

A diagnosis of urethral trauma was made in 39 cases in 38 men. Patients ranged in age from 41 to 85 years (mean age, 60 years). Causes of the urethral injuries were iatrogenic urethral injury during catheter placement (n = 18), traumatic self-removal of a catheter (n = 12), straddle injuries (n = 6) and motor vehicle accidents (n = 3). All patients underwent failed blind urethral catheterisation. After urethrography, we attempted to insert a hydrophilic guidewire through the urethra into the urinary bladder, and then to place a 3-way balloon retention urethral catheter into the bladder guided by prior passage of the guidewire under fluoroscopy.

RESULTS

Of 39 attempts of inserting the urethral catheter into the urinary bladder, 34 (87.2%) were successful. Of 5 failures (12.8%), 2 were American Association for the Surgery of Trauma (AAST) urethral injury type 3 and 3 were type 4/5. Among these, there were 3 cases of pseudolumen formation.

CONCLUSIONS

Hydrophilic guidewire-assisted urethral catheterisation in patients with urethral trauma is a safe, simple technique for relieving acute bladder retention after a failed attempt at blind catheterisation.

KEY POINTS

Hydrophilic guidewire-assisted urethral catheterisation is useful following failed blind catheterisation. Immediate management of urethral injury is important to reduce morbidity. Hydrophilic guidewire-assisted urethral catheterisation can be applied immediately after diagnostic urethrography.

Endourological reconstruction of posterior urethral disruption

While conventional methods of urethroplasty for posterior urethral disruption usually are successful technically, they may be associated with complications and often require the expertise of a specialist. Therefore, the option of an endourological approach to the treatment of the obliterated posterior urethra would be highly desirable if a comparable surgical outcome could be achieved. We describe a closed controlled method of posterior urethral reconstruction following traumatic avulsion of the posterior urethra. Urethral continuity was re-established by endoscopic identification of the true prostatic outlet, its fixation with an angiography wire and a Goodwin sound, retrograde visual urethrotomy through the fibrotic segment and balloon dilation of the entire posterior channel. Postoperative anatomical and functional results were excellent, and were achieved with much less risk and cost to the patient than those of a perineal or transpubic urethroplasty.

Interventional radiology in the treatment of retroperitoneal trauma

Interventional radiology is used most often in the management of the trauma patient to control hemorrhage and drain fluid collections. Transcatheter arterial embolization is an effective, expeditious, and safe technique for the nonoperative control of renal and other retroperitoneal bleeding, arteriovenous fistulas, and pseudoaneurysms. Transcatheter drainage of renal and other retroperitoneal collections of pus, urine, and blood is successful in more than 90% of trauma patients; such drainage should be attempted prior to any surgical intervention. Other procedures, such as antegrade nephrostomy, ureteral stenting and dilatation, angioplasty of traumatic renal artery stenosis, and suprapubic cystostomy, are infrequently indicated but provide alternatives to standard surgical intervention.