Closed (subcutaneous) breaks the urethra

Closed (subcutaneous) breaks the urethra occur most often in bolotnoe and webbed part. When a person with the power sits astride narrow solid object (edge boards, the edge of the fence, the chair) or gets hit in the crotch with his foot, kicking horse, etc., easy to injure fixed here bulbosa the urethra. More often the cause of damage is a fracture of the pelvis bones, mainly pubic and the ascending branch of the sciatic to which membranous Department urethra is fixed tight ligaments. Fragments of bone from the sides, and fixed them the urethra is broken more often in membrane Department, but often the gap extends to bulbous part of it. Damage to the urethra directly fragments of bones is rare.
When penetrating the rupture of the urethral lumen reported with others parauretral fabrics, i.e. there is a gap of all layers. When non-penetrating break the lumen of the urethra is not communicating with parauretral fiber. These include the gap only mucosa or only fibrous membrane with the corpus cavernosum, or without them.
Complication penetrating breaks the urethra are urinary leakages. If the wound bolotnogo Department urethral integrity of the urogenital diaphragm is violated, urinary leakages do not penetrate into the cavity, pelvis, urine can investirovat only fiber perineum, scrotum, anterior abdominal wall and thighs, and she fills in tissue only during urination.
Serious complication are urinary leakages, developing when damage to the urethra above urogenital diaphragm, i.e. behind the external sphincter. Continuously doing the pelvis, urine quickly permeates kolapushinu fiber and, decomposing, causing extensive phlegmon and purulent fusion pelvic fiber, as if vnebrachnyi rupture of the bladder.
General condition of the patient after a closed injury of the anterior urethra, not complicated fracture of the pelvis, often remains satisfactory. The gap, caused by the fracture of the pelvis, accompanied by severe, and sometimes fatal shock.
The characteristic symptoms of closed injuries of the urethra are urethrorrhea, perineal urogenital, urine retention.
The blood stands out from the urethra drops regardless of urination or external opening of the urethra visible dried blood.
The blood poured out not only in the lumen of the urethra, but in the surrounding tissue, bruises forming on the perineum, scrotum, or in the region of symphysis.
When damage to the urethra above urogenital diaphragm (prostate Department) blood enters the pelvis and urethrorrhea can be absent.
If the urethra is broken on all circle, isolated from each other segments her apart and urination becomes impossible. Penetrating breaks only the bottom or side walls, observed most often, also often accompanied by urinary retention due to the crush zone or stratification of the urethral wall and hemorrhages in the surrounding tissue, causing compression and distortion of the urethra.
Attempts to urinate cause infiltration of damaged tissues urine that accompanied the cutting pain. Shed abroad urine quickly acquires, develops cellulitis periuretralnuu fiber with stunning chills and painting septicemia.
In some cases urination occurs due to reflex spasm of the sphincter of the bladder.
The diagnosis. When examining a patient first drew the attention of urethrorrhea as distinguished from the urethra or blood dried blood film at the outer holes of her. Periodically sharply painful sterile urine urgency. Distended bladder protrudes above the pubis in the form of oval tumors, located symmetrically on both sides of the middle line. Percussion above the symphysis is determined by the dullness of percussion sound, often reaching up to the navel.
On the ground urinary satekov and bleeding - on the scrotum, penis, in suprapubic, inguinal region - felt infiltrates, leather purple-blue color, edematous, without folds and glitter.
In injuries membranous Department urethra haematoma on the perineum is formed in 1-2 days after the injury in the form of a butterfly's wings.
Catheterization of the urethra to diagnose aimless and unsafe. It causes an injury, contributes to the development of infection. To hold the catheter into the bladder is usually not possible, and if possible, a diagnosis that is not specified.
Damage to the urethra may be specified by urethrography, which allowed when fresh injury, if after it will be laid bare the place of damage, drained leakages and thus will be removed caught in tissue contrast liquid.
Urethrography made with 20% solution of sergazina with the addition of 200 000 UNITS of penicillin, gives an idea of the nature of damage to the urethra, on the distribution and size of the urinary satekov (Fig. 130).
Treatment. If the urine is not broken and there is only reasonable urethrorrhea, you can wait for its termination, without resorting to surgery, as damage may be non-invasive. In most cases, however, immediately or shortly after the injury occurs urinary retention, and then it is necessary first of all to take her by the imposition suprapubic fistula. Hematoma and urinary leakages on the crotch of open and drain. In urinary Salecah in the pelvic fiber is the drainage basin, as if vnebrachnyi rupture of the bladder. If immediately the cystostomy cannot be made, as a temporary measure used capillary biopsy of the bladder.
Suturing damaged urethra directly after damage to its (primary closure), rarely used. The operation is performed on crushed tissues, blood-soaked and infiltrated in most cases, urine, and because the primary healing is rare, despite the use of antibiotics.
It is preferable to restore the urethra in 2-3 months after discharge of urine when resorption of hematomas and urinary satekov.