Rupture of the urethra is a serious injury. If you do not provide timely assistance to the patient, then such damage can lead to dangerous consequences. Often, the destruction of the tissues of the urethra is accompanied by bone fractures and ruptures of nearby organs. What are the signs of a urethral injury? And is it possible to do without surgery? We will consider these issues in the article.
General characteristics of injury
Rupture of the urethra is an injury to the urethra with a violation of the integrity of its walls. This injury is more common in men than in women. This is due to gender differences in the structure of the urinary tract. In men, the urethra is much longer (up to 23-25 cm). It runs inside the external genital organ and is open to bumps and bruises. The length of the urethra in women is about 2 cm, the urinary canal is located in the pelvic cavity, and it is more difficult to injure.
When the membranes of the urethra break, blood circulation in the organ and the outflow of urine are disturbed. Due to irritation of the receptors, a pronouncedpain syndrome. In case of injury, not only tissues are destroyed, but also blood vessels, so the rupture is often accompanied by bleeding.
Reasons
The urethra is a fairly durable organ. Most often, with injuries of the urethra, a bruise occurs with the formation of an internal hematoma. The integrity of tissues is violated only with strong and sharp mechanical impacts on the perineum. Urologists identify the following causes of urethral rupture:
- Bruises. In men, such an injury occurs when falling from a height and playing sports. The rupture occurs when the perineal area hits a hard object. In women, the cause of the injury is often a pelvic fracture. Broken bones can damage the lining of the urethra.
- Violent action. The integrity of the walls of the urethra can be broken due to the impact on the perineum. The injury can also be caused by a gunshot or stab wound.
- Animal bites. In medical practice, there have been cases of organ rupture due to bites from aggressive dogs and attacks from wild animals.
- Urological procedures. Tissue rupture can occur with inaccurate cystoscopy, as well as during catheterization and bougienage of the urethra.
- Difficult delivery. Urethral rupture in women most often occurs as a result of obstetric trauma. During childbirth, the urethra can be squeezed by the head of a large fetus. Also, rupture can occur due to rough obstetrical manipulations, such as forceps.
Classification
BIn medicine, this injury is classified depending on the degree of damage. Urethral rupture is divided into the following varieties:
- Partial break. When examined on the wall of the urethra, torn tissue can be seen. However, the parts of the body are not separated from each other. If you seek medical help in time, it is possible to treat the injury with conservative methods.
- Full break around the circumference. This is a more severe injury in which one part of the urethra separates completely from the other. A gap is visible between the torn tissues. The integrity of the organ can only be restored by surgery.
Separately allocate crushing of the urethra. This is an injury in which the walls of the organ are destroyed as a result of strong compression. This is the most severe damage. It is accompanied by extensive trauma to the membranes of the organ. In this case, the treatment is carried out only by surgical methods.
General symptoms
Signs of injury may vary slightly between patients of different sexes. However, common manifestations of urethral rupture in men and women can be distinguished:
- difficulty urinating;
- hematoma in the perineum and genitals;
- pain in the urethra;
- reddish impurity in morning urine;
- bleeding from the urethra between urination.
Hematuria (blood in the urine) is not necessarily a sign of organ damage. With partial rupture of bleedingmay not be, if there was no destruction of the vessels. But even in the absence of spotting, injuries to the urethra are always accompanied by severe pain in the perineum.
With a complete rupture of the urethra, additional symptoms appear:
- Disappearance of urination. If the parts of the urethra are completely separated from each other, then it becomes impossible to empty the bladder naturally.
- Pain and heaviness in the lower abdomen. This symptomatology occurs due to the overflow of the bladder.
Features of symptoms in men
In male patients, rupture of the urethra is often accompanied by a fracture of the penis. With such an injury, the integrity of the protein membranes of the organ is violated. This injury most often occurs with severe bruises and blows with blunt objects.
In this case, there are additional signs of rupture of the urethra in men:
- acute unbearable pain;
- crunch at the moment of injury or impact;
- pronounced large hematoma extending to nearby tissues;
- severe swelling of the penis;
- dick deformation;
- discharge of blood from the urinary canal;
- urinary retention.
This is a dangerous injury that requires immediate medical attention. Without treatment, a fracture can be complicated by a purulent infection and sepsis.
Features of trauma in women
In case of injuries in women, a partial rupture of the urethra most often occurs. Full breakparts of the urethra from each other is extremely rare.
As already mentioned, women get similar injuries with pelvic fractures or difficult births. Often in patients, not only the urethra is damaged, but also a nearby organ - the vagina. There is a rupture of the anterior vaginal wall. A sign of such damage is the release of urine from the genital tract. This is accompanied by sharp pain in the perineum, which is aggravated by being in a sitting position.
Complications
Rupture of the urethra is a fairly serious injury. With such damage, the patient needs emergency medical care, and sometimes urgent surgery. Lack of timely treatment can cause the following complications:
- Traumatic shock. Such a consequence occurs with severe injuries in more than half of the victims. The state of shock in 7-10% of cases causes the death of the patient.
- Inflammatory processes in the excretory organs (cystitis, pyelonephritis). Stagnation of urine creates a favorable environment for the reproduction of bacteria. This leads to inflammation of the bladder and kidneys.
- Narrowing of the urethra. This complication may occur long after the injury. A sign of narrowing of the urethral canal is severe cutting pain during urination.
- Urinary infiltration. With the destruction of the walls of the urethra, urine seeps into the tissues of the small pelvis. This leads to the formation of infiltrates, which eventually suppurate.
- Osteomyelitis. If to injurya bacterial infection joins, then the inflammatory process can move from the excretory organs to the pelvic bones.
- Urosepsis. When an injured area becomes infected, bacteria can enter the bloodstream and spread throughout the body. Blood poisoning poses a great danger to the patient's life.
- Incontinence. Often, after the rupture has healed, there is constant leakage of urine.
The consequence of rupture of the urethra in men can be impotence. Erectile dysfunction after trauma is sometimes quite persistent and difficult to treat. This complication most often occurs after combined injuries of the urethra and the tunica of the penis.
First Aid
In case of minor injuries, the patient should immediately visit a urologist or go to an emergency room. In severe general condition of the patient, it is necessary to call an ambulance. At the pre-medical stage, the following measures should be taken:
- The victim must be laid on his back in the "frog pose". The lower limbs should be bent at the knees and spread apart. If the patient does not have a state of shock, then a roller or a high pillow should be placed under the head.
- The injured perineum should be covered with a cruciform bandage.
- An ice compress or a heating pad with cold water should be put on the site of the bruise. This will help reduce pain and swelling.
Further assistance to the patient is provided in a hospital setting.
Diagnosis
If you suspect a urinary tract injurychannel appoint the following diagnostic examinations:
- Ultrasound. This examination shows the condition and degree of damage to the walls of the urethra. However, this method is applicable only for men. In women, the urethra is not accessible for accurate ultrasound diagnosis.
- Retrograde urethrography. A contrast agent is injected into the urethra, and then an x-ray is taken. This helps to visualize damage to the walls of the urinary canal in the picture.
- Cystoscopy. The doctor examines the bladder with an endoscopic instrument. A catheter with an optical system at the end is inserted through the urethra. Invasive diagnosis in case of rupture of the urethra is carried out under mandatory ultrasound control in order to avoid additional tissue damage. Cystoscopy reveals a combined injury of the bladder and urethra.
Additionally, a clinical urinalysis is prescribed. With injuries in the urine, the number of red blood cells increases. An x-ray of the pelvis is also shown, this helps to identify possible bone fractures. Women are advised to undergo a gynecological examination, while men may need to consult an andrologist.
Conservative Therapy
You can do without surgery only with a partial rupture of the urethra. Treatment with conservative methods is effective only if the patient seeks help no later than 6-12 hours after the injury.
The patient is shown bed rest. Under the control of ultrasound, catheterization of the bladder is performed. This is necessary to normalize the outflow of urine. The rubber catheter is left in the urethra for 7-10days.
Patients are prescribed the following groups of drugs:
- antibiotics;
- hemostatic agents;
- anti-inflammatory drugs;
- analgesics.
These drugs are taken orally or by injection, and are also injected through a catheter directly into the urethra and bladder.
Surgical methods
Surgery is necessary in the following cases:
- with complete rupture of the walls of the urethra;
- when you see a doctor late (after 6-12 hours after injury).
As already mentioned, a penile fracture is quite often combined with a rupture of the urethra in men. Treatment with conservative methods for such a combined injury is ineffective, and the patient requires surgery.
In some cases, surgery is performed on an emergency basis. However, quite often the operation is postponed for 2-3 weeks. During this time, bladder catheterization is performed through a puncture in the lower abdomen. And only after stabilization of the patient's condition do plastic surgery of the urethra.
The operation consists in connecting the gaps and suturing. It is carried out under general anesthesia. In the postoperative period, the patient is prescribed a course of antibiotics to prevent infectious complications.
Full recovery of he alth occurs several months after surgery. DurationThe rehabilitation period depends on the volume and complexity of the operation. Within 5 years after urethroplasty, the patient must be observed by a urologist.
Preventive measures
How to avoid damage to the urethral canal? The following recommendations from urologists must be followed:
- It is very important to protect the genital area from bruises and bumps.
- Wear a protective groin brace during sports.
- Invasive urological procedures should only be performed by qualified professionals.
- In case of any (even minor) bruises in the groin area, it is necessary to urgently visit a doctor. This will allow timely identification of the extent of damage.
These measures will help reduce the risk of damage to the urethra and the development of complications after bruises. It is important to remember that injuries to the urethra and genitals are much easier to prevent than to treat.
