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Introduction: Penile fracture with rupture of the urethra is a rare and underreported case in Urology. We present this case received at the Emergency Department of Urology at the State University Hospital of Haiti. Case Study: A 49 years old man was seen with a 6 hours history of urethrorrhagia with pain and deformation of the penis. The symptoms occurred following sexual intercourse with use of a stimulant in a doggy style position. The patient was taken to the OR 12 hours after presentation, a circular incision was initiated through the balanopreputial groove to deglove it to the root. A wound of the corpus cavernosum at 2.5 cm from the meatus was noted with a partial anterior urethral injury about 3 cm in length. Conclusion: The diagnosis of penile fracture is essentially clinical and does not require imaging. Urgent surgical management is necessary to reduce the risk of long-term complications.

peer-reviewed Data on urethral catheter related injuries is sparse. In this study we aimed to characterise urethral diametric strain and urinary catheter inflation pressure thresholds that precede human urethral trauma during urethral catheterisation (UC). Human urethras were obtained from patients undergoing male to female gender reassignment surgery [(n = 9; age 40 ± 13.13 (range: 18–58)) years]. 12Fr urinary catheters were secured in the bulbar urethra and the catheter's anchoring balloon was inflated with a syringe pump apparatus. Urethral diametric strain and balloon pressure were characterised with video extensometry and a pressure transducer respectively. Immunohistochemistry, Masson's trichrome and Verhoeff-Van Gieson stains evaluated urethral trauma microscopically. Morphological characterisation of the urethral lumen was performed by examining non-traumatised histological sections of urethra and recording luminal area, perimeter and major/minor axis length. Tearing (n = 3) and rupture (n = 3) of the urethra were observed following catheter balloon inflation. The threshold for human urethral rupture occurred at an external urethral diametric strain ≥ 27% and balloon inflation pressure ≥ 120kPa. Significant relationships were identified between urethral wall thickness and the level of trauma induced during catheter balloon inflation (p = 0.001) and between the pressure required to inflate the catheter balloon and the length of the major axis of the urethral lumen (p = 0.004). Ruptured urethras demonstrated complete transection of collagen, elastin and muscle fibres. In conclusion, urethral rupture occurs at an external urethral diametric strain ≥ 27% or with balloon inflation pressures ≥ 120 kPa. Incorporation of these parameters may be useful for designing a safety mechanism for preventing catheter inflation related urethral injuries.

Summary Background Blunt trauma to the paediatric pelvis is associated with urethral rupture, sometimes even without a bony fracture. While such rupture of the male urethra has received considerable mention, female urethral injury is both less common and has received less attention. Objective We describe 4 cases of urethro vaginal injury associated with pelvic fracture, its varied presentations and the modalities employed in its management. Patients and methods A retrospective study was done to identify 4 patients who presented to our institution between 2007 and 2018. All 4 girls suffered a loss of a urethral segment ranging from the distal urethra (n = 2) to complete urethral loss (n = 2) and rupture of the bladder neck in one. All 4 girls also had associated vaginal injury resulting in varied clinical presentation including total urinary incontinence, urocolpos, vaginal voiding via an acquired hypospadias and urinary retention with late onset haematocolpos. All were managed initially with SPC and three of them underwent urethral substitution with Monti ileal tube in two and vestibular mucosal flap in one. The hypospadiac neo-meatus was continent and was left alone. The ruptured vagina was repaired by rectus muscle interposition, direct suturing, posterior vaginal U flap or colonic patch. An appendicular Mitrofanoff was added for safety in 2 girls. Results Follow up was done till June 2019 (range 1–12 years). All patients voided satisfactorily and were fully continent. Normal menstrual function was present in the 3 post pubertal children. Conclusion A traumatic force capable of causing urethral injury may often result in associated vaginal injury and should not be overlooked. Thus urinary retention is not the only presentation of urethral injury in girls. Fistulation to the vagina may result in continent or incontinent vaginal voiding if the vagina has not been transected and urocolpos/haematocolpos in those with vaginal transection. Various modalities maybe employed to maintain continuity of the urethra and vagina including use of bowel and local flaps.

Fracture of the penis is a relatively uncommon condition that is most likely under-reported. It commonly results from excessive force applied to the long axis of the penis in the erect state causing rupture of the tunica albuginea of the corpus cavernosum during masturbation, sexual intercourse, or penile manipulation. Immediate surgical exploration is the treatment of choice in most cases to maintain good erectile function. Concomitant total or incomplete urethral and corpus spongiosum ruptures are even rarer and are usually repaired surgically together with the penile fracture. When the penile fracture and urethral lesions are small, they may be treated conservatively. This is sufficient to preserve good erectile function. We report such a case in an adult who bent his erect penis while sleeping, presented with massive urethral bleeding, and was managed conservatively.

Objective: In order to evaluate the efficacy of different surgical techniques for the correction of traumatic lesions of the urethra, we per formed a retrospective study in those patients, and evaluated different complications such as postsurgical stenosis of the urethra, inconti nence and impotence (erectile dysfunction). Methods: A retrospective study was conducted, reviewing the clinical charts of 43 patients admitted to the San Vicente of Paul Hospital, with diagnosis of traumatic rupture of the posterior urethra from 1987 to 2007. We analyzed different demographic data, type of surgical cor rection, early and late complications. Results: The average age of the patients was 7.7 years, the average follow up was 30.6 months, and all the patients were male with a pos terior urethral rupture. 27 Patients underwent a primary urethral repair (63%), 13 patients underwent a cistostomy with later urologic reconstruction (30%), in 3 patients (7%) other surgical procedures were made. Overall complication rate was 39.5%. These complications were: Urethral stenosis, 26 patients (60.5%), urinary retention secondary to obstruction, 10 patients (23.3%), incontinence 10 patients (23.3%) and impotence 7 patients (16.3%). Patients treated with a primary urethral repair presented a significantly less development of infection, obstruction and stenosis. (p

Rupture of corpora cavernosa is a rare disease in young adults. In western countries, the most frequent cause is the so-called "faux pas du coit". In the Middle East, masturbation and penis manipulations aimed at stopping morning erection are the most frequent causes. The fracture which is audible by the patient is accompanied by a rapid detumescence with progressive onset of a haematoma. Diagnosis is based on clinical findings but radiological investigations such as MRI, ultrasonography or cavernography may help localizing the exact fracture site. The treatment of albugineal ruptures is surgery, in an elective manner whenever possible; it consists in the eviction of the subcutaneous haematoma, the suture of the albuginea and treatment of a potentially associated urethral rupture. Conservative treatment is exceptional and limited to patients who reject surgery, since it generates more complications: painful erections, persistent haematoma with a risk of infection, arteriovenous fistula, impotence, and unrecognized urethral rupture. Patients must be clearly informed on all these complications.

Objectives To evaluate the long-term urologic, orthopedic, and psychological outcome of children after posterior urethral rupture (PUR) due to pelvic trauma. Methods We retrospectively reviewed the records of 49 children with PUR from 1986 to 2000. The long-term urologic results were determined by voiding function, continence, and erectile function. The orthopedic results were determined by pelvic radiography and a questionnaire. Psychiatric diagnoses were made using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria and the Structured Clinical Interview for DSM-IV Axis I Disorders. Results The mean follow-up was 12 years (range 4 to 17). The average age was 8 years at the time of the trauma and 20 years at the last follow-up. Urethral continuity was achieved in 97.9% of the children. Of the 49 patients, 19 had at least one urologic complication, 18 had orthopedic pathologic findings, and 21 had psychiatric diagnoses. The number of urologic procedures required (more than three), presence of long-term complications, and total number of hospitalizations (more than three) secondary to the injury significantly affected the development of a psychological disorder. Conclusions The results of our study have shown that posttraumatic PUR in children is associated with a significant rate of long-term complications. Nonoperative treatment of pediatric pelvic fractures associated with PUR has been quite successful. Repeated operations, the presence of long-term urologic complications, and frequent and long hospital stays result in serious attendant psychological problems. Therefore, careful and prolonged follow-up of posttraumatic urethral injury with a multidisciplinary approach is necessary to provide better outcomes and a better quality of physical and social life for these children.

Objectives To determine whether delayed excision and primary anastomosis is appropriate after failed previous therapeutic attempts for post-traumatic membranous urethral strictures. Delayed excision and primary anastomosis is widely accepted as the first-line treatment of post-traumatic membranous urethral strictures. Methods A review of the medical records identified 13 patients who had undergone anastomotic urethroplasty as a second procedure for traumatic membranous urethral strictures. The previous treatments in these patients included anastomotic urethroplasty in four, staged urethroplasty in four, and endoscopic urethrotomy or primary catheter realignment in five. The mean stricture length was 2.8 cm. All patients underwent excision and primary bulboprostatic anastomosis using the perineal approach. Results Four patients required partial pubectomy and one required corporal rerouting to achieve anastomosis. The mean follow-up was 27 months. Urethrography performed 1 month postoperatively demonstrated a widely patent anastomosis in all cases. Flexible urethroscopy performed 1 year after surgery revealed a widely patent anastomosis with normal urethral mucosa in all patients but one. The mean maximal flow rate at the last follow-up visit was 23.5 mL/s compared with 3.9 mL/s preoperatively. No statistically significant postvoid residual urine volume was found in any patient. One patient developed an anastomotic stricture 3 months after surgery that was treated successfully by internal urethrotomy. Thus, the objective success rate was 92%. Subjectively, all patients but one reported satisfactory voiding. Complications were mild and included urinary tract infection, bladder stone formation, and decreased erectile function in 1 patient each. Conclusions Even in patients with failed previous surgical attempts, excision and primary anastomosis is feasible and provides good surgical results in post-traumatic posterior urethral strictures. The complications were mild and easily treated.

The authors relate a retrospective study on 30 cases of urethral stenosis and four cases of urethral rupture with a mean follow up of 28 months (8 to 44 months). The mean age of the patients was 47.5 years (6 to 85 years). The main aetiology was inflammatory sclerosis (73.5%). The predilection was bulbar (52.94%). The main symptom was constituted by dysuria (n = 24). The peri-urethral sclerosis was found in 44, 12% of cases. The penile flap as tube or patch. Immediate complications were a loosen of sutures (n = 7), urinary fistula (n = 4). The later complications were essentially recidives (n = 6). The results were good in 73.5% of cases.

Radiography is a familiar and available imaging modality for the evaluation of patients with acute abdominal distress. Potential causes for acute abdominal distress include the hepatobiliary system, spleen, urogenital tract, and gastrointestinal tract. Radiographic signs associated with specific conditions are described, including gastric-dilation volvulus, urinary bladder rupture, ureteral rupture, urethral rupture, pancreatitis, and small intestinal obstruction. Additionally, contrast procedures that can be beneficial in evaluating the patient with acute abdomen, including positive contrast cystography, urethrography, excretory urography, and peritoneography, are described.

OBJECTIVE In order to evaluate the efficacy of different surgical techniques for the correction of traumatic lesions of the urethra, we performed a retrospective study in those patients, and evaluated different complications such as postsurgical stenosis of the urethra, incontinence and impotence (erectile dysfunction). METHODS A retrospective study was conducted, reviewing the clinical charts of 43 patients admitted to the San Vicente of Paul Hospital, with diagnosis of traumatic rupture of the posterior urethra from 1987 to 2007. We analyzed different demographic data, type of surgical correction, early and late complications. RESULTS The average age of the patients was 7.7 years, the average follow up was 30.6 months, and all the patients were male with a posterior urethral rupture. 27 Patients underwent a primary urethral repair (63%), 13 patients underwent a cistostomy with later urologic reconstruction (30%), in 3 patients (7%) other surgical procedures were made. Overall complication rate was 39.5%. These complications were: Urethral stenosis, 26 patients (60.5%), urinary retention secondary to obstruction, 10 patients (23.3%), incontinence 10 patients (23.3%) and impotence 7 patients (16.3%). Patients treated with a primary urethral repair presented a significantly less development of infection, obstruction and stenosis, (p

We report a rare case of penile fracture with complete urethral rupture in a 25-year-old male who sustained the injury during sexual intercourse. He presented with a tense haematoma on the ventral aspect of the penile shaft, associated with per urethral bleeding. Despite the injury, he was able to void painfully. Retrograde urethrography revealed complete obstruction at the proximal third of the urethra. Exploration and repair of the penile fracture and urethra were performed. The patient made an uneventful recovery with good erectile and voiding function. This case illustrates the value of retrograde urethrography in assessing urethral injuries in patients with penile fracture.

Fifty-six patients with urethral injuries comprised 35 involving the posterior urethra and 21 involving the anterior urethra. Immediate retrograde urethrography confirmed the clinical diagnosis made when blood was found at the external urinary meatus after external trauma. Traffic accidents caused most of the posterior urethral injuries and were associated with severe injuries to multiple systems and a significant mortality rate (34 per cent). Primary realignment of the urethral injury by a urethral catheter in all cases of urethral rupture (plus a suprapubic cystostomy in most of these cases) resulted in a stricture rate of 62 per cent on follow-up. However, only half of these strictures required surgical correction. The incidence of incontinence was 10 per cent and of impotence 38 per cent.

SUMMARY After external trauma, the patient with bladder injury usually complains of lower abdominal pain and tenderness, and macroscopic or microscopic hematuria is usually present. Simultaneous bladder and posterior urethral rupture can occur in male patients, and the diagnosis of both ruptures is rarely made preoperatively. A delayed presentation with an acute abdomen, absence of voiding, and elevated blood urea nitrogen is sometimes seen in a patient injured during a prolonged alcoholic state or domestic beating, after which the patient is reluctant to seek medical attention, or with a physician misdiagnosis. In patients with pelvic fractures, the incidence of bladder rupture is 6 to 10 per cent. A retrograde cystogram with bladder filling of 400 ml of radiopaque dye followed by a washout film will diagnose intraperitoneal and extraperitoneal ruptures of the bladder. False-negative cystograms occur with penetrating injuries of the bladder when only 250 ml or less of contrast medium is used to fill the bladder.

The use of pubectomy in the repair of urethral strictures has not been favored because of the supposed excessive blood loss and operative time and long-term pain. However, in our experience with 30 patients with traumatic urethral rupture, we have found that pubectomy provides excellent exposure with a mean blood loss of 800 ml and few postoperative problems. The technique should nonetheless be reserved for selected patients and performed only by experienced surgeons.