Urinary tract rupture
Introduction
Introduction The male urethra is a muscle mucosal tube, about 20cm long, which can be divided into two sections, with the urinary genital warts as the boundary. The anterior urethra is a cavernous body, including the penis head, penis and ball, with a total length of 15 cm. The posterior urethra includes a membrane portion and a prostate portion, and is about 5 cm long. The male urethra has two curves of pubic bone and pubic bone. The subpubic curvature is basically fixed, and the pubic anterior curvature disappears when the penis is attached to the lower abdomen. The back of the urethra is shorter than the ventral surface and is fixed. When the penis is in a relaxed state, there are many wrinkles in the ventral surface of the urethra. The urethral mucosa is rich in glands and is soft in nature; the submucosal tissue is rich in blood supply.
Cause
Cause
(1) The vast majority of urethral injuries are caused by the application of transurethral instruments or the discharge of foreign bodies (such as stones). A small number of abnormal, drunk or mental patients with needles, iron wire, glass and other foreign objects inserted into the urethra and cause damage, mis-injection of certain chemical drugs such as silver nitrate, copper sulfate, carbolic acid, etc. can cause chemical burns. Transurethral resection of the urethra can cause electrical burns in the urethra.
(B) extra- urinary tract injury This injury is more common than intraurethral injury. Can be a through injury or a closed injury. The former is mainly seen in the battlefield, and the urethra is worn by firearms or sharp weapons. Most of the injured parts are in the ball and membrane. The cavernous body and the prostate are rare. Closed urethral injury can be seen during wartime and peacetime. The injured part of the perineum riding a cross injury or kick injury is more common in the ball and membrane urethra, and with pelvic fractures, often accompanied by prostate urethral injury.
Examine
an examination
Related inspection
Urethral examination for urethral function test
[Physical examination]
1. Pain in the urethra, which is exacerbated during urination
2. Hemorrhage in the urethra.
3. Urinary dysfunction.
4. Extravasation of urine: rupture of the anterior urethra, extravasation of the urine in the penis, scrotum, perineum; rupture of the posterior urethra, extravasation of the urine in the extraperitoneal space outside the bladder.
5. Pelvic fracture combined with posterior urethral rupture, rectal examination can touch the floating and up-moving prostate.
6. Try to insert the catheter, and you can't enter the bladder.
7. If necessary, take X-ray film or urethral cystography.
Diagnosis
Differential diagnosis
1. Extraperitoneal bladder rupture: may be combined with a pelvic fracture or with a posterior urethral rupture. Posterior pubic space, urinary extravasation of the surrounding tissues of the bladder, dysuria, and anuria may occur. However, the extraperitoneal bladder rupture often has no bladder filling, but is in an empty state; the catheter is inserted smoothly, and no urine or only a little hematuria is taken out; the rectum refers to the prostate without displacement.
2. Kidney damage: After the kidney injury, hematuria can occur throughout the whole process, and may be accompanied by long strips of blood clots, but no blood in the urethra; pain and swelling, blood stasis at the waist, not the perineum; no dysuria. Excretory urography should be performed when necessary.
3. Spinal cord injury: urinating difficulties may occur after trauma, and acute urinary retention occurs. But often accompanied by neurological symptoms and signs, such as perineal sensation loss, anal sphincter relaxation.
