Urethral rupture refers to serious injuries. If the patient is not helped in time, 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 an 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. Such damage 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 passes inside the external genitalia 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 harder to injure.
When the urethral membranes rupture, the blood circulation in the organ and the outflow of urine are disrupted. Due to irritation of the receptors, a pronounced pain syndrome occurs. When injured, not only tissues but also blood vessels are destroyed, so the gap is often accompanied by bleeding.
Causes
The urethra is a fairly solid organ. Most often, with injuries of the urethra, a bruise occurs with the formation of an internal hematoma. Tissue integrity 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 gap occurs when the crotch region hits a solid object. In women, the cause of injury is often a fracture of the pelvis. Bone debris can damage the urethra.
- Violent acts. The integrity of the walls of the urethra may be impaired by striking the perineum. The cause of injury can also be a gunshot or stab wound.
- Animal bites. In medical practice, there have been cases of organ rupture due to bites of aggressive dogs and attacks of wild animals.
- Urological procedures. Tissue rupture can occur with inaccurate cystoscopy, as well as with catheterization and urethral bougieurage.
- Hard birth. Rupture of the urethra in women most often occurs as a result of obstetric injuries. At birth, the urethra can be squeezed by the head of a large fetus. Also, a rupture can occur due to rough execution of obstetric manipulations, for example, the application of forceps.
Classification
In medicine, this injury is classified according to the degree of damage. The urethral rupture is divided into the following varieties:
- Partial break. When examined on the wall of the urethra, torn tissue sections can be noticed. However, the parts of the organ are not separated from each other. If you seek medical help in time, then it is possible to treat injury with conservative methods.
- Complete gap around the circumference. This is a more severe trauma in which one part of the urethra is completely separated from the other. Between the torn off tissues a gap is noticeable. Restoring the integrity of the organ can only be done surgically.
Separate the 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, treatment is carried out only by surgical methods.
Common symptoms
Signs of injury may vary slightly in patients of different sexes. However, we can distinguish the general manifestations of urethral rupture in men and women:
- difficulty urinating
- hematoma in the perineum and genitals;
- soreness in the urethra;
- reddish admixture in the morning urine;
- the allocation of blood from the urethra in the intervals between urination.
Hematuria (blood in the urine) is not a mandatory sign of organ damage. With a partial rupture of bleeding, there may not be any bleeding if vascular destruction has not occurred. But even in the absence of bloody discharge, trauma of the urethra is always accompanied by severe pain in the perineum.
With a complete rupture of the urethra, additional symptoms appear:
- The disappearance of urination. If the parts of the urethra are completely torn off from each other, then it becomes impossible to empty the bladder naturally.
- Pain and heaviness in the lower abdomen. Such symptoms occur due to overflow of the bladder.
Features of symptoms in men
In male patients, urethral rupture 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 damage most often occurs with severe bruises and blows with blunt objects.
In this case, additional signs of urethral rupture in men appear:
- acute unbearable pain;
- a crunch at the time of a bruise or shock;
- pronounced large hematoma, spreading to nearby tissues;
- severe swelling of the penis;
- member deformation;
- excretion 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 purulent infection and sepsis.
Features of injury in women
With injuries in women, a partial rupture of the urethra occurs most often. Complete separation of the parts of the urethra from each other is extremely rare.
As already mentioned, women receive similar injuries in pelvic fractures or complex births. Often, not only the urethra is damaged in patients, but also the nearby organ - the vagina. There is a rupture of the anterior vaginal wall. A sign of such damage is the excretion of urine from the genital tract. This is accompanied by acute pain in the perineum, which is worse when in a sitting position.
Complications
Urethral rupture refers to rather severe injuries. With such damage, the patient needs emergency medical care, and sometimes an emergency operation. Lack of timely treatment can cause the following complications:
- Traumatic shock. This consequence occurs with severe injuries in more than half of the victims. The shock state in 7-10% of cases causes the death of the patient.
- Inflammatory processes in the organs of excretion (cystitis, pyelonephritis). With stagnation of urine, a favorable environment for the reproduction of bacteria is created. This leads to inflammation of the bladder and kidneys.
- Narrowing of the urethra. Such a complication may occur after a long period of time after an injury. A sign of narrowing of the urethral canal is severe cutting pain during urination.
- Urinary infiltration. When the walls of the urethra are destroyed, urine seeps into the tissues of the pelvis. This leads to the formation of infiltrates, which eventually suppurate.
- Osteomyelitis. If a bacterial infection joins the injury, the inflammatory process can go from the organs of excretion to the bones of the pelvis.
- Urosepsis. When an infected area is infected, bacteria can enter the bloodstream and spread throughout the body. Blood poisoning poses a great danger to the patient's life.
- Urinary incontinence. Often after rupture of the rupture, constant leakage of urine is noted.
Impairment may result from rupture of the urethra in men. Erectile dysfunction after an injury 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 the emergency room. With a serious general condition of the patient, it is necessary to call an ambulance team. At the pre-medical stage, the following measures should be taken:
- The victim must be laid on his back in a "frog pose". The lower limbs should be bent at the knees and divorced in different directions. If the patient does not have a shock condition, then a roller or a high pillow should be put under his head.
- A crisscross bandage should be applied to the injured crotch.
- A compress with ice or a heating pad with cold water should be put in place of the bruise. This will help reduce pain and swelling.
Further assistance to the patient is provided in a hospital setting.
Diagnostics
If you suspect an injury to the urethra, the following diagnostic tests are prescribed:
- Ultrasound This examination shows the condition and degree of damage to the walls of the urethra. However, this method is applicable only to men. In women, the urethra is not accessible for accurate ultrasound diagnosis.
- Retrograde urethrography. A contrast agent is injected into the urethra, and then radiography is done. This helps to visualize damage to the walls of the urinary canal.
- Cystoscopy The doctor examines the bladder with an endoscopic device. A catheter with an optical system at the end is inserted through the urethra. Invasive diagnosis of urethral rupture is performed under the mandatory supervision of an ultrasound scan to avoid additional tissue damage. Cystoscopy reveals a combined injury to the bladder and urethra.
Additionally, a clinical urine test is prescribed. With injuries in urine, the number of red blood cells increases. X-ray of the pelvis is also shown, this helps to identify possible bone fractures. Women are advised to undergo a gynecological examination, and men may require an andrologist's consultation.
Conservative therapy
You can do without surgery only with a partial rupture of the urethra. Conservative treatment 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 7-10 days.
The following groups of drugs are prescribed to patients:
- antibiotics
- hemostatic agents;
- anti-inflammatory drugs;
- analgesics.
These drugs are used in oral or injectable form, and are also injected through a catheter directly into the area of the urethra and bladder.
Surgical methods
Surgical intervention is necessary in the following cases:
- with a complete rupture of the walls of the urethra;
- with a late visit to the doctor (later 6-12 hours after the injury).
As already mentioned, a fracture of the penis is often combined with a rupture of the urethra in men. Treatment with conservative methods with such a combined injury is ineffective, and the patient needs surgery.
In some cases, surgery is carried out on an emergency basis. However, quite often the operation is delayed 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 the urethra plastic.
The operation consists in connecting the sections of the gap 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 health occurs a few months after surgery. The duration of the rehabilitation period depends on the volume and complexity of the operation. Within 5 years after urethroplasty, the patient must be observed by a urologist.
Preventative measures
How to avoid damage to the urethral canal? The following recommendations of urologists must be observed:
- It is very important to protect the genital area from bruises and bumps.
- During sports, a special protective bandage for the groin should be worn.
- Invasive urological procedures should be trusted only by qualified specialists.
- For any (even minor) bruises of the inguinal region, it is urgent to visit a doctor. This will allow time to identify the degree 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.