Lower Urinary Tract Trauma: Difference between revisions

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====== Technique ======

* Approach

* '''<span style="color:#ff0000">Approach (2)'''

**Ventral vertical penoscrotal incision

*#'''<span style="color:#ff0000">Ventral vertical penoscrotal incision'''

***Usually preferred for direct exposure to the fracture because most penile fractures occur ventrally or laterally.

*#*Usually preferred for direct exposure to the fracture because most penile fractures occur ventrally or laterally.

** Distal circumcising incision

*# '''<span style="color:#ff0000">Distal circumcising incision'''

***May be appropriate when the location of the fracture is uncertain because it provides exposure to all three penile compartments.

*#*May be appropriate when the location of the fracture is uncertain because it provides exposure to all three penile compartments.

*See [https://www.youtube.com/watch?v=T0hoHpDxeCE Video]

*Equipment

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** Evacuate hematoma

***Dissection must be carried down until the hematoma within Buck's fascia is exposed and evacuated

**Identify defect

**'''Identify defect'''

***Proximal corpora is the most common site of rupture

****Induction of an artificial erection with saline or colored dye may aid in locating the corporeal ~~laceration.~~

****'''<span style="color:#ff0000">Induction of an artificial erection with saline or colored dye may aid in locating the corporeal laceration♦'''

***Laceration usually transverse in direction

***Obtain adequate exposure of defect

**Repair defect

***Repair defect in tunica albuginea with interrupted 2-0 or 3-0 PDS sutures.

** If urethral injury

** '''If urethral injury'''

***Partial urethral injuries should be oversewn with fine absorbable suture over a urethral catheter.

***'''Partial urethral injuries should be oversewn with fine absorbable suture over a urethral catheter'''

***Complete urethral injuries should be debrided, mobilized, and repaired in a tension-free fashion over a catheter.

***'''Complete urethral injuries should be debrided, mobilized, and repaired in a tension-free fashion over a catheter'''

** Test repair

***Apply tourniquet proximal to repaired defect

@@ Line 368: / Line 368: @@
 ====== Technique ======
-* Approach
+* '''<span style="color:#ff0000">Approach (2)'''
-**Ventral vertical penoscrotal incision
+*#'''<span style="color:#ff0000">Ventral vertical penoscrotal incision'''
-***Usually preferred for direct exposure to the fracture because most penile fractures occur ventrally or laterally.
+*#*Usually preferred for direct exposure to the fracture because most penile fractures occur ventrally or laterally.
-** Distal circumcising incision
+*# '''<span style="color:#ff0000">Distal circumcising incision'''
-***May be appropriate when the location of the fracture is uncertain because it provides exposure to all three penile compartments.
+*#*May be appropriate when the location of the fracture is uncertain because it provides exposure to all three penile compartments.
 *See [https://www.youtube.com/watch?v=T0hoHpDxeCE Video]
 *Equipment
@@ Line 399: / Line 399: @@
 ** Evacuate hematoma
 ***Dissection must be carried down until the hematoma within Buck's fascia is exposed and evacuated
-**Identify defect
+**'''Identify defect'''
 ***Proximal corpora is the most common site of rupture
-****Induction of an artificial erection with saline or colored dye may aid in locating the corporeal laceration.
+****'''<span style="color:#ff0000">Induction of an artificial erection with saline or colored dye may aid in locating the corporeal laceration♦'''
 ***Laceration usually transverse in direction
 ***Obtain adequate exposure of defect
 **Repair defect
 ***Repair defect in tunica albuginea with interrupted 2-0 or 3-0 PDS sutures.
-** If urethral injury
+** '''If urethral injury'''
-***Partial urethral injuries should be oversewn with fine absorbable suture over a urethral catheter.
+***'''Partial urethral injuries should be oversewn with fine absorbable suture over a urethral catheter'''
-***Complete urethral injuries should be debrided, mobilized, and repaired in a tension-free fashion over a catheter.
+***'''Complete urethral injuries should be debrided, mobilized, and repaired in a tension-free fashion over a catheter'''
 ** Test repair
 ***Apply tourniquet proximal to repaired defect