Bulbous urethra injury

The bulbar urethra is an important part of the male urethra and can be injured due to various factors. In this case, surgery is a better way to treat bulbar urethra injury. A typical example is bulbar urethra injury repair and anastomosis. We must have a comprehensive understanding of the surgical situation, make all preparations for the operation, and strive to achieve the best treatment effect. Let us now learn more about this surgery.

Indications

1. Difficulty urinating after injury, inability to insert a urinary catheter into the bladder, confirmed to be urethral rupture or rupture.

2. Patients with urine extravasation and large local hematoma after injury.

Contraindications

1. Closed urethral injury lasts for more than 72 hours, and open injury lasts for more than 24 hours. Due to local tissue edema and congestion, urethral repair and anastomosis is not suitable, and only suprapubic cystostomy and urine extravasation incision and drainage can be performed.

2. If bulbar urethra injury is accompanied by other life-threatening tissue and organ injuries, other life-threatening injuries should be treated first. For patients with unstable injuries, urethral repair and anastomosis are not performed, only suprapubic cystostomy is performed.

Surgical procedures

The general steps of the operation are: ①Perineal incision to fully expose the entire bulbar urethra. ② Longitudinal incision of the bulbospongiosus muscle will reveal the injured part of the urethra. ③ Find the urethral stump and free it. ④ Anastomosis of the urethra. ⑤Close the incision and place drainage. ⑥Drain extravasated urine.

Postoperative complications

Bleeding, urinary extravasation, urinary fistula, infection, urethral stenosis.

Postoperative Care

Routine care, patency and fixation of urinary catheter and cystostomy tube, strict bed rest for 1 to 5 days after surgery, and then mainly bed rest with light activities; health education.

Precautions

1. Properly secure the indwelling urinary catheter and flush it 2 to 3 times a day to keep it unobstructed.

2. Use antibiotics to prevent and treat infection.

3. Taking female hormones and sedatives can inhibit penile erection, especially young and middle-aged patients should pay more attention to this.

4. Be careful to prevent the incision from being contaminated by defecation. People with constipation should have an enema before defecation.

5. The rubber drainage sheet for incision should be removed 48 hours after surgery, and the urine extravasation drainage sheet should be removed daily starting from 72 hours after surgery according to the disappearance of local swelling.

6. The catheter left in the urethra should be removed 7 to 14 days after the operation.

7. For patients who have difficulty urinating after surgery, the urethra can be dilated once before discharge. For those with difficulty urinating, the cause should be identified and urethrography or urethroscopy should be performed if necessary. If it is due to local scar hyperplasia, regular urethral dilation should be performed.