Penis and Urethra Surgery: Difference between revisions

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*#* Very rare and are predominately due to a psychological component.
*#* Very rare and are predominately due to a psychological component.


== Pelvic fracture urethral injuries ==
== Pelvic Fracture Urethral Injuries ==


* '''See AUA Urethral Stricture Guideline Notes'''
* '''See AUA Urethral Stricture Guideline Notes'''
* PFUIs are the result of blunt pelvic trauma and accompany ≈10% of pelvic fracture injuries
 
== Pathogenesis ==
*PFUIs are the result of blunt pelvic trauma and accompany ≈10% of pelvic fracture injuries
** Although total disruption of the urethra is possible with a straddle injury, '''straddle injuries most commonly involve only the bulbar urethra'''
** Although total disruption of the urethra is possible with a straddle injury, '''straddle injuries most commonly involve only the bulbar urethra'''
** '''Distraction injuries are unique to the membranous urethra'''
** '''Distraction injuries are unique to the membranous urethra'''
*** '''The most frequent point of distraction is at the departure of the bulbous urethra from the membranous urethra'''
*** '''The most frequent point of distraction is at the departure of the bulbous urethra from the membranous urethra'''
* '''Diagnosis and Evaluation'''
 
** Important to define the precise anatomy of the pelvic fracture injury before treatment is undertaken
=== Diagnosis and Evaluation ===
** A '''cystogram''' outlines the bladder and provides information about rostral displacement of the proximal urethra'''.'''
* Important to define the precise anatomy of the pelvic fracture injury before treatment is undertaken
*** '''The appearance of the bladder neck on contrast studies or on antegrade endoscopy does not accurately predict the ultimate function of the bladder neck after urethral reconstruction'''
* '''Imaging'''
**** '''In the past, great reliance was placed on whether the bladder neck was closed or open on cystography.'''
**'''Cystogram'''  
***** '''Lack of contrast in the prostatic urethra would suggest a competent, closed bladder neck whereas contrast in the prostatic urethra would suggest an incompetent, open bladder neck'''
***'''Provides information on (3):'''
****** '''A lack of contrast material in the posterior urethra gives some information, about the integrity of the bladder neck. However, contrast material may opacify the prostatic urethra when the bladder neck is more than adequately competent for continence'''
***#'''Rostral displacement of the proximal urethra'''
* '''Repair'''
***#'''Bladder outline'''
***#'''Bladder neck competency'''
***#*'''Contrast in the prostatic urethra suggests an incompetent, open bladder neck'''
***#*'''Lack of contrast in the prostatic urethra suggests a competent, closed bladder neck'''
***#**'''The appearance of the bladder neck on contrast studies or on antegrade endoscopy does not accurately predict the ultimate function of the bladder neck after urethral reconstruction'''
***#***'''Although a lack of contrast material in the posterior urethra gives some information about the integrity of the bladder neck, contrast material may opacify the prostatic urethra when the bladder neck is more than adequately competent for continence'''
***#***In the past, great reliance was placed on whether the bladder neck was closed or open on cystography.
 
=== Management ===
*'''Repair'''
** In most cases, PFUIs are not long, and the resultant obliteration is amenable to a technically straightforward mobilization of the corpus spongiosum with a primary anastomotic technique.
** In most cases, PFUIs are not long, and the resultant obliteration is amenable to a technically straightforward mobilization of the corpus spongiosum with a primary anastomotic technique.
*** '''Aggressive mobilization of the corpus spongiosum is performed with caution, because it is thought to have possible ill effects on retrograde blood supply, which in the pelvic fracture patient may be tenuous.'''
*** '''Aggressive mobilization of the corpus spongiosum is performed with caution, because it is thought to have possible ill effects on retrograde blood supply, which in the pelvic fracture patient may be tenuous.'''