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A ruptura uretral iatrogênica geralmente é uma intercorrência secundária à passagem forçada de sondas rígidas durante a tentativa de desobstrução uretral; procedimento este realizado como forma de eliminação imediata da urina em casos de retenção aguda, a fim de proporcionar maior conforto ao animal e melhoria das condições clínicas. Felinos são frequentemente acometidos por distúrbios urinários e a uretrostomia é a intervenção cirúrgica indicada quando a tentativa de desobstrução não tem sucesso ou quando o animal apresenta constantes recidivas. O presente estudo tem como objetivo demonstrar o uso de uma técnica de desvio urinário temporário em felino com ruptura de uretra, feito a partir da inserção de uma sonda tipo Foley na região ventral da bexiga e fixação desta à parede abdominal para que a urina pudesse ser conduzida ao meio externo.

Background Girls’ pelvic fracture bladder neck avulsion and urethral rupture is rare however it causes great morbidity. The management is complex and not standard yet. We report our experience and a technique of bladder neck reconstruction with anterior bladder wall flap. Methods We retrospectively analysed data of 5 girls with pelvic fracture bladder neck avulsion and urethral rupture admitted to our institution from July 2017 to October 2019. They all came to our institution with a suprapubic tube. Patients’ trauma was all initially treated at other hospitals, 4 had suprapubic cystotomy and 1 had urethral realignment. One girl also had three other urethroplasties at other hospitals. We took pubectomy, posterior ureth roplasty and bladder neck reconstruction with anterior bladder wall flap in these 5 girls. Post-operative assessments included voiding cystourethrography, uroflowmetry and urethroscopy after urethral catheter removal. Verbal consent to participate was obtained from the parent or legal guardian of the children. Results Operation time ranged from 120 to 180 min. Follow-up time is 12 to 27 months. Uroflowmetry showed that maximum urine flow rate improved significantly. Cystourethrography indicated good continuity of the urethra. Two girls had urinary incontinence postoperatively but were continent 3 months later. One patient developed vesical-abdominal fistula and got repaired by surgery 6 months later. She was continent ever since. Other complications were not observed during the follow-up period. Conclusions Our method of bladder neck reconstruction using bladder flap as a patch is feasible and provides good continence, especially for those with serious bladder neck avulsion and urethral rupture caused by extensive trauma and those who had posttraumatic urethral distraction needed second repair.

OBJECTIVE To evaluate the feasibility of buccal mucosal graft urethroplasty for repairing complete urethral rupture in cats. ANIMALS 15 male domestic shorthair cats with traumatic complete urethral rupture. PROCEDURES In each cat, a section of buccal mucosa was harvested, sutured, and formed into a tubule by use of an 8F indwelling catheter as support. This tubular graft was connected to both ruptured ends of the urethra to renew the urinary passage. The catheter was left in place until the absence of leakage was confirmed by positive contrast retrograde urethrography. After spontaneous urination was confirmed, cats were discharged from the hospital. Six months later, urethrography was repeated and owners were asked to score their cats’ urinary function and quality of life. RESULTS 13 cats recovered well following surgery, with no complications in the oral cavity or surgical site and no signs of difficulty or discomfort when urinating. Urethrography 2 weeks and 6 months after surgery revealed no stricture or leakage in the abdominal cavity. The 2 remaining cats developed a urethral stricture and underwent second surgery with a successful outcome. At the 6-month follow-up, 14 cats had only mild urinary signs, and 1 cat had incontinency. Owners indicated they were delighted (n = 14) or pleased (1) with their cats’ quality of life. CLINICAL RELEVANCE Buccal mucosa was found to be a good source of graft tissue for performance of urethroplasty in male cats, yielding satisfactory outcomes with few postoperative complications. The described technique may be suitable for severe and complicated cases of urethral rupture in male cats.

Traumatic testicular dislocation is a rare complication secondary to different kinds of accidents. A 61-year-old man, who was injured by wall collapse and was diagnosed as pelvic fracture and posterior urethral rupture 5 months ago, came to the urologic department to seek urethral reconstruction. However, thorough physical examination and imaging examination confirmed a round mass in the right inguinal region and an empty right scrotum, which support diagnosis of testicular dislocation. The patient did not take the initiative to complain about that because he thought the right testis had been destroyed by the accident already. So the patient underwent fiber cystourethroscopy, urethral reconstruction, and orchiopexy. No testicular atrophy was confirmed at follow-up. We reviewed previous reports about traumatic testicular dislocation and analyzed the cause of delayed diagnosis.

Penile fracture is a rare urologic emergency. The main finding is a partial disruption of one or both cavernosal bodies due to blunt trauma of the penis during an erection. Complete or partial injury of the urethra may accompany the penile fracture but complete urethral rupture is rarely encountered. In this study, we present the management of a penile fracture case with disruption of both corpus cavernosum with total urethral rupture.

Highlights • About 10% of traumatic injury patients have genitourinary involvement. • Immediate exploration and urethral reconstruction is indicated in urethral trauma. • Urethra rupture with anorectal laceration can be treated with primary anastomosis., Introduction The initial management of urethral trauma remains disputed, and there are several suitable techniques, including delayed repair and suprapubic urinary diversion as well as primary endoscopic or open alignments. The treatment choice used depends on the rupture’s location and length as well as the accompanying trauma. Case presentation A 33-year-old male patient was referred to the department of emergency, with the chief complaint of inability to void experienced 1 day before being admitted, after falling from a height of approximately three meters. There was a laceration to the perineum 3 cm long to the rectum, with no active bleeding. After the incident, the patient could not void, but the lower abdomen was not painful. Upon retrograde urethrography examination, contrast extravasation of the bulbous urethra was seen through the anorectal laceration. Immediate debridement and repair for the anorectal wound, then primary anastomosis for the bulbous urethra, was performed. Discussion The likelihood of an injury to the anterior urethra increases with certain clinical features, including blood in the urethral meatus, palpable bladder distention, and a butterfly appearance on the perineum. Immediate exploration and reconstruction of the urethra is recommended in urethral traumas associated with penile fractures and non-life-threatening penetrating injuries. Furthermore, small lacerations are repaired primarily, while total ruptures are treated with anastomosis. Conclusion Proper identification and management of urethral rupture determines the outcome. Initial urethral trauma management is disputed; however, a bulbous urethra rupture with anorectal lacerations can be treated safely and effectively with primary anastomosis.

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.

A 3-month-old male DSH cat was presented with a history of lethargy, anorexia, dysuria, urinary incontinence, dermatitis and swelling in the perineal area following a road traffic trauma. Retrograde positive-contrast urethrography revealed an intra-pelvic urethral rupture which was managed by performing transurethral catheterisation. Due to accidental removal, the case was presented for re-examination following a progressive urine scald dermatitis several days later. So, surgical placement of cystostomy tube was performed. The cat regained his ability to urinate normally a week later and the catheter was withdrawn. The extensive perineal dermatitis due to urine scald necessitated delayed primary closure. Topical and systemic antibiotics were administered for 2 weeks and second intention wound healing was completed after 5 weeks.

We herein report a rare case of nontraumatic urethral rupture. The patient presented with oliguria, perineal pain and anorexia, and a 3 cm fistula was located in the perineum. Computed tomography revealed a retroperitoneal abscess invading the urethra, and a retrograde urethrogram revealed the rupture of the membranous urethra. He had no history of perineum trauma or transurethral procedures. Although he underwent a suprapubic cystostomy and conservative therapy by antibiotics, he eventually died.

A variety of retrievable and other types of temporarily placed stents are currently being used. However, only a few studies have considered primary endoscopic realignment with temporary urethral stent insertion in the event of traumatic bulbar urethral injury. We aimed to compare the clinical effectiveness and complications between thermo-expandable urethral stents and polymer-coated bulbar urethral stents (BUSs) for the treatment of traumatic bulbar urethral strictures. Between September 2011 and March 2018, 30 patients who had been diagnosed with complete bulbar urethral rupture following blunt trauma underwent temporary urethral stent placement after primary realignment. Thermo-expandable nickel-titanium alloy urethral stents were placed for 15 patients (group M), and retrievable self-expandable polymer-coated BUSs were placed for another 15 patients (group A). All stents were removed within 6 months after placement. The complications and maintained patency rates were compared between the two groups. The mean stent indwelling period was 5.0 ± 2.5 months in group M and 4.9 ± 4.0 months in group A. Both groups maintained high patency rates (Group M 12/15 (80.0%) and group A 13/15 (86.7%)). Five patients who developed urethral stricture underwent direct visual internal urethrotomy (DVIU), and no patients required repeat DVIU or open surgical urethroplasty. Both groups maintained the mean maximal urinary flow rate (Qmax) at 12 months after stent removal. Discomfort (46.7% vs. 6.7%), granulation tissue formation (73.3% vs. 26.7%) and post-void dribbling (80.0% vs. 20.0%) were more frequent in group M than in group A (p = 0.013, p = 0.011 and p = 0.001, respectively). In conclusion, both stents were effective for managing traumatic complete bulbar urethral rupture after primary realignment. However, the thermo-expandable urethral stents had a higher complication rate while the stent was in situ than the BUSs.

Objective To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. Materials and Methods We searched the Pubmed database between 1998 and 2019 using the following key words: “penile fracture”, “fracture of penis”, “trauma to penis”, “rupture of corpora cavernosa”, “urethral injury”, “urethral rupture” and “urethral reconstruction”. Results The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. Conclusion PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is mandatory and produces satisfactory results with low levels of 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.

Made available in DSpace on 2022-04-28T19:06:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-03-01 Abdominal urethral rupture commonly occurs in male dogs after traumatic pelvic fractures and can lead to uroperitoneum, causing peritonitis and azotemia. The primary complications of urethral damage include strictures, incontinence and innervation injury. Here, we describe a case report of prostatic urethral rupture, treated by primary suture repair, that yielded early healing and recovery in a ten-year-old, male, mixed-breed dog who visited our facility within 24 hours of being struck by a car. Positive contrast urethrocystography resulted in leakage of the contrast medium into the abdominal cavity in a point caudal to the urinary bladder. Additional radiography revealed multiple pelvic fractures. During surgery, we found a laceration of the right prostatic lobe causing urethral rupture. We performed a full thickness simple continue suture with 7-0 polyglactin 910 to reestablish urethral continuity. The prostate capsule was also sutured in a simple continue pattern. A previously placed indwelling urinary catheter was kept inside to divert urine flow. On the third postoperative day, the animal withdrew the urinary catheter and started to urinate by himself. The conservative treatment of pelvic fractures enabled complete return to function on the 55th day. One hundred and fifty days after the trauma, no evidence of urinary stricture or another clinical sign was observed. Urethral wounds can be treated surgically by primary suturing and urinary diversion. A short healing time was experienced, and the indwelling urinary catheter was removed three days after surgery since there was no more urine leakage and the animal began voiding normally. Departamento de Cirurgia e Anestesiologia Veterinária Universidade Estadual Paulista Júlio de Mesquita Filho Departamento de Cirurgia e Anestesiologia Veterinária Universidade Estadual Paulista Júlio de Mesquita Filho

Penile fracture is a rare urological emergency caused by blunt trauma to the erect penis and it may be accompanied by urethral injury. Complete urethral rupture is very uncommon and is usually managed by primary anastomosis. However, these patients are more likely to develop post-operative complications such as urethral strictures. Buccal mucosa graft is commonly used for substitution urethroplasty in management of urethral strictures, but its use has not been reported for immediate treatment in the setting of penile fracture. We report a patient with rupture of both corpora cavernosa, as well as the rupture of the urethra, after sexual intercourse. Buccal mucosa graft was used for surgical repair of urethral injury. At 36-month follow-up patient did not experience erectile or voiding problems. The application of this technique could possibly reduce the incidence of urethral strictures in these patients and further prospective studies with larger samples should be conducted.

Introduction: Traumatic stricture urethra is a rare entity, with surgery being the only treatment modality. We aim to evaluate and analyse the surgical outcomes and erectile function in patients who undergo surgical treatment for traumatic urethral stricture disease at our institution. Material and Methods: A prospective study was conducted on 57 male patients who presented between Aug 2015 and Dec 2017 in our institution, with post traumatic stricture urethra. The urethral rupture was confirmed by RGU and patients underwent suprapubic catheterisation initially. At 3 months these patients underwent delayed anastomotic urethroplasty. The patients were followed up for 6 months- 24 months. Erectile function was assessed by IIEF-5 questionnaire pre operatively and post-operatively at 6 months. Results: Mean age of patients was 38.5 years. Majority of the patients (36.84%) were between 21 to 30 years of age..Majority of the patients (32) had road traffic accidents (indirect) and 12 patients had history of fall/direct trauma to perineum or urethra. Twelve (21.05%) patients developed complications postoperatively. Early complications of wound infection occurred in 08 (14.03%) patients. Late complications were seen in 12 (21%) patients i.e. restenosis. Erectile dysfunction is seen in 42.11% patients at the end of six months. Overall surgical success rate was 78.9 % at 6 months. Conclusion: Delayed anastomotic urethroplasty is an effective procedure for traumatic urethral strictures with good surgical results. Recurrence of stricture is most common complication. But, surgical procedure leads to some degree of erectile function.

Background : Serious urethral damage or recurrent obstructions in felines require a urethrostomy to provide a return to and maintenance of urinary flow. In some cases, urethral reconstruction with complementary tissue is required. Grafting of autogenous vascularized intestinal segments is widely used in human medicine to promote the functional restoration of the urethra, but in veterinary medicine, its use is still incipient. Thus, the aim of this report was to analyze and describe the use of thein functional urethral repair in a feline diagnosed with a severe urethral rupture. Case : A castrated male cat presented with urethral obstruction. Emergency decompression cystocentesis was performed, and fluids and analgesics were administered. Catheterization and urohydropropulsion were attempted to relieve the obstruction, without success. An emergency perineal urethrostomy was indicated. After the procedure, the diagnosis (obstructive lower tract urinary disease) and the infeasibility of restoring urinary flow by conventional urethrostomy techniques were confirmed. We opted for a laparoscopic-assisted prepubic urethrostomy; the pre-prostatic urethra was transected, and its caudais end was brought through an abdominal incision cranially. However, urethral tension was noted after this maneuver was performed. Thus, we decided to use autogenous vascularized intestinal segment grafting for urethral reconstruction. A segment of the ileum was prepared for grafting, with preservation of irrigation and mesenteric innervation. A termino-terminal anastomosis was performed on the stumps of the remaining intestine, and the mesentery was sutured. The ileal graft was isolated and washed to remove luminal content. A tunnel was made in the abdominal muscles, subcutaneous tissue, and skin of the prepubic region; the cranial end of the intestinal graft was passed through this tunnel. A Foley catheter was passed through the graft, in sequence in the remaining urethra and urinary bladder. The luminal size difference between the caudal end of the graft and urethra was corrected by wedge-shaped cut, and a suture was made. Repair points were made between the caudal end of the graft and urethra across the entire circumference. The knots were then executed. Suturing of the abdominal wall was routine. To make the ostomy, the end border of the graft was externalized, and the antimesenteric border was cut and sutured to the skin. Finally, a Foley catheter was attached to the skin. The cat was kept in the hospital for 72 hours and then discharged. Regular clinical assessments took place for a year following the operation. Discussion : Transoperative maneuvers for obtaining and applying the graft were feasible, of medium complexity, and suitable for maintaining vitality of the grafted segment of tissue and restoring immediate urinary flow. Regular clinical evaluations over the course of a year, as well as ultrasonography and tomography of the urinary tract in the first half of the year, proved the effectiveness of the grafting technique; the cat’s urinary flow was normal, and there were no signs of rejection to the intestinal graft. We conclude that an autogenous graft of vascularized intestinal segments is a good urethral substitute and has significant therapeutic value for cases in which urethral reconstruction is necessary, particularly when other surgical techniques are not feasible.

La fracture du pénis est une urgence urologique rare, définie comme une rupture traumatique de la tunique albuginée du corps caverneux. Elle touche essentiellement le sujet jeune au cours de l'activité sexuelle. Le but de ce travail était de rapporter les résultats de la prise en charge de 06 cas de fracture de verge observés dans le service d'Urologie-Andrologie du Centre Hospitalier Universitaire Sanon Souro (CHUSS) de Bobo-Dioulasso. Il s'agissait de six patients d'âge moyen de 38,3 ans, reçu pour tuméfaction douloureuse de la verge pour 04 cas et d'urétrorragie persistante pour 02 cas au décours de faux pas du coït ou de manipulation forcée de la verge. La tuméfaction douloureuse de la verge avec la verge en “aspect d'aubergine” a été le principal signe retrouvé. Le traitement a consisté en une évacuation de l'hématome intra-caverneux suivi d'une albuginorraphie pour 05 cas et pour un cas d'un traitement conservateur. Les suites opératoires ont été simples pour l'ensemble des patients.

Background: Management of partial or complete traumatic urethral disruptions of the posterior urethra in children and adolescents, secondary to pelvic fracture poses a challenge. Controversy exists as to the correct acute treatment of posterior urethral injuries and delayed management of PFPUDDs. We reviewed the urological literature related to the treatment of traumatic posterior urethral injuries and delayed repair of these distraction defects in children and adolescents. Material and Methods: There are few long-term outcomes studies of patients who underwent PFPUDDs repairs in childhood; most reports included few cases with short follow up. We excluded studies in which the cohort of patients was heterogeneous in terms of stricture disease, etiology and location. Results: Primary cystostomy and delayed urethroplasty is the traditional management for PFPUIs. Immediate repair is rarely possible to perform. Realignment of posterior urethral rupture in children is indicated in special situations: (a) concomitant bladder neck tears, (b) associated rectal lacerations, (c) long disruptions of the urethral ends. Before delayed reconstruction ascending urethrography and micturating cystourethrogram along with retrograde and antegrade urethroscopy define site and length of the urethral gap. However, the most accurate evaluation of the characteristics of the distraction defect is made when surgical exposure reveals the complexity of the ruptured urethra. Partial ruptures may be managed with urethral stenting or suprapubic cystostomy, which may result in a patent urethra or a short stricture treated by optical urethrotomy. The gold standard treatment for PFPUDDs in children is deferred excision of pelvic fibrosis and bulbo-prostatic tension-free anastomosis, provided a healthy anterior urethra is present. Timing of delayed repair is at 3 to 4 months after trauma. Some urologists prefer either the perineal access or the transpubic approach to restore urethral continuity in children with PFPUDDs. Substitution urethroplasties are used in children with PFPUDDs, when anastomotic repair can't be achieved due to severe damage of the bulbar urethra. Conclusion: As evidenced in this review the progressive perineo-abdominal partial transpubic anastomotic repair has advantages over the isolated perineal anastomotic approach in patients with "complex" PFPUDD. This approach provides wider exposure and facilitates reconstruction of long or complicated posterior urethral distraction defects.

Background: Penile fracture is a urological emergency and requires urgent medical attention. There was a relative upsurge in 2020. Diagnosis is usually based on typical history and examination findings suggestive of penile fracture. The objective of this study was to determine the demographics, clinical presentation and management of fracture of the penis.Methods: All patients who presented at the accident and emergency in 2020 with penile fracture were studied. The patients age, time to presentation, mechanism of injury, clinical features (cracking sound, pain, immediate detumescence, penile swelling, urethral bleeding and acute urinary retention) were recorded. Intraoperative findings (location of corpora rupture, length of tear and urethral rupture) were recorded and analysed.Results: Twelve patients were studied. The mean age was 34.8 years, range (20 years to 56 years). 58.3% presented within 24 hours of trauma. The commonest mechanism of penile fracture was sexual intercourse with the woman on top position (58%). 75% of the patients heard a popping sound. All patients had pain, detumescence and penile swelling (N=12) 100%. Two patients had urethral bleeding (N=2) 16.7%, with one having associated urethral rupture (N=1) 8.3%. Two patients had acute urinary retention (16.7%). Rupture of the right corpora occurred in 50%, 8.3% had bilateral rupture of the corpora. All the patients had repair of the corporal rupture. Urethral injury was repaired primarily. Erection and voiding post-repair were satisfactory.Conclusions: Fracture of the penis is a urological emergency. Diagnosis can be made based on typical history and examination findings. Prompt surgical intervention is advised to avoid complications and erectile dysfunction.

Objective: To report the experience with patients treated by early endoscopic realignment of complete post-traumatic rupture urethra. Methods : The cross sectional study included 30 patients in Dhaka Medical College Hospital and different private hospitals in Dhaka, Bangladesh, between April 2010 and March 2014 with post traumatic complete posterior urethral disruption. Pre-operative retrograde urethrography (RGU), micturition cysto urethrography (MCU) and ultrasonography (USG) of abdomen were performed to identify and to evaluate the Urethral defect length, the bladder neck competence, the prostate position and extend of pelvic hematoma. In second week after trauma, antegrade and retro-grade urethroscopy were performed to identify both urethral ends and insert a catheter. Before removal of catheter, Patients were followed up by pericatheter urethrogram after 4 weeks completed postoperative period. If extravasation seen, catheter was again maintained for another 2 weeks. Follow up was done by abdominal ultrasound and uroflowmetry 3 monthly up to 6 months and 6 monthly thereafter. RGU and MCU were performed 8 weeks after removal of catheter. Urinary continence and post-operative erectile dysfunction were assessed by direct patient interview. Results : 30 patients in the age group 18-60 years (mean 36 years) were treated. Patients were followed up for 12 to 36 months. Complete healing of the urethra occurred in 10 patients. Passable urethral stricture developed in 12 patients. Complete urethral obstruction occurred in 8 patients. Conclusion : Early endoscopic realignment for complete posterior urethral rupture is a feasible technique with no or minimal intra-operative complications. The technique is successful as the definite line of therapy in reasonable number of patients and it is seems to be effective Intervention for the prevention of inevitable urethral stricture formation. J Dhaka Medical College, Vol. 24, No.2, October, 2015, Page 136-140

To evaluate the effects, particularly the incidence of anastomotic fistula, of a pedicled dartos flap around the urethral orifice in the treatment of urethroplasty of mid-shaft hypospadias. A total of 46 cases of congenital mid-shaft hypospadias were included in this study. The patients ranged in age from 0.7 to 25.4 years and the average was 5.8 years. The patients received penis chordee correction. A transverse preputial island flap was developed for urethral reconstruction. The proximal dartos of the urethral orifice was used to develop a pedicled dartos flap, which was transposed to cover and strengthen neourethral anastomosis. The ventral penile skin defect was repaired by another flap. The 46 patients were examined during follow-up visits for 6 months to 3 years. An anastomotic fistula was observed in one case (2.2 %). Scar healing without fistula was observed in another patient due to poor blood supply to part of the ventral penile skin. No other incidences of fistula, urethral rupture, flap necrosis, wound infections, urinary tract (meatal) stenosis, or urethral diverticulum were observed in the patients. A pedicled dartos flap around the urethral orifice can take advantage of well-vascularized local tissue to add a protective layer to the proximal aspect of the neourethral anastomosis for reducing the incidence of anastomotic fistula in mid-shaft hypospadias repair using a transverse preputial island flap. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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.

Penile fracture is not uncommon blunt trauma to the penis. Here, we present a rare case of penile fracture during sexual intercourse. The patient presented with penile swelling, bleeding per urethra, and inability to pass urine. Retrograde urethrogram showed significant extravasation of contrast from anterior penile urethra and no contrast passing to proximal urethra. Surgical exploration showed complete urethral rupture and bilateral cavernosal rupture. This case represents the value of urethrogram to evaluate the urethral injury and the association of complete urethral injury with bilateral ventral cavernosal injury.

Background: Penile fracture is a relatively rare urologic emergency. It is defined as traumatic rupture in tunica albuginea of corpus cavernosum. Traditionally, surgeon explores the penis in full-length by complete degloving of its skin and repairs any defect in the tunica. Imaging modalities such as ultrasound and MRI may be of help to reveal the exact site of tunica defect preoperatively for tailoring the surgical repair by making a direct incision over the defect. Tunica albuginea is a hyperechoic layer in ultrasound covering corpora cavernosa, and its tear appears as a hypoechoic defect in this band. In MRI, tunica is seen as a low-signal intensity layer in all conventional pulse sequences around the corpora cavernosa, and its tear is evident as a discontinuity in this layer. In addition, imaging modalities may demonstrate associated injuries such as hematoma, urethral rupture, and corpus spongiosum injury. Objectives: To investigate accuracy of ultrasound and magnetic resonance imaging (MRI) in penile fracture diagnosis and preoperative mapping. Methods: 18 consecutive patients included in the study during two years prospectively. Ultrasound and MRI were performed in all patients and interpreted by two expert radiologists independently. The defect site was mapped on a designed platform preoperatively using each modality blinded to the result of other modality. All patients were explored surgically by an expert surgeon using complete degloving of the penis technique, which was the routine procedure in our tertiary referral center. The surgeon was blinded to the radiologic mapping, and the surgical results were considered as the gold-standard. Detection rate, and agreement between preoperative imaging mapping and surgical result were determined for each modality. Results: Mean age of patients was 28.2 ± 7.3 years-old. Most penile fractures were occurred during sexual intercourse (89%). Most common location of tunica rupture was mid-shaft of penis (67%), and mean length of tunica defect was 14.8 ± 3.2 mm. All patients had associated hematoma, but no one revealed urethral injury. Detection rate of ultrasound and MRI was 89% and 100%, respectively. Ultrasound was unable to detect tunica rupture in 2 patients (11%), all of which revealed tears at the penile base in MRI and during surgical exploration. Ultrasound mapped tear location correctly in 13 patients (kappa, 0.26; P = 0.045), while MRI mapped it precisely in 17 cases (kappa, 0.89; P = 1.00). Conclusions: Both imaging modalities may be used for detecting tunica tear especially in atypical cases that physical examination is equivocal. However, MRI is more accurate in preoperative mapping of rupture location for performing a modified less invasive surgery.This is an abstract presented in the 33rd Iranian congress of radiology (ICR) and the 15th congress of Iranian radiographic science association (IRSA)

This study done at Father Muller medical college hospital aimed at throwing light on a less known and rather ignored subject that is urethral injury in all its perspective. We studied the various patterns, etiology, clinical presentations of urethral injury along with diagnostic and therapeutic interventions practiced here. The detailed data analysis revealed the male predominance with younger age group being the victims of urethral injury. The commonest cause being trauma. Bulbar urethral rupture was common compared to membranous part and diagnosis facilitated usually by retrograde urethrogram. Majority of them underwent early endoscopic realignment with or without supra pubic cystostomy prior to it. We stress upon the fact that early realignment of the injured urethra should be first priority.

The aim of this report is to evaluate clinical findings and treatment of infected scrotal wounds and traumatic urethral rupture in two dogs. The material of this report consists of two Kopay breed hunting dogs, aged 3.5 and 8, brought to the Adnan Menderes University, Faculty of Veterinary Medicine Surgery Clinic. In both cases, the wounds had been caused by a wild boar and an open, infected wound with seromucous discharge was present. The wound had laid both testes bare in the first dog, while in the second dog, only the right testis was present, the left without testis. It was detected that the urethra was ruptured in the scrotal area when a urinary catheter sent through external urethral orifice came out of the wound. Both cases underwent surgery to repair the urethra and to perform wound revision. In both cases, the catheters were left in place postoperatively until the postoperative 10 th d. Follow-up examination indicated that both animals could urinate without any problems.

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.

SummaryUse of a bilateral caudal superficial epigastric skin flap and perineal urethrostomy for reconstruction of a wound which occurred secondary to rupture of the distal urethra and extravasation of urine is reported. A 10-month-old male neutered Domestic Shorthaired cat was presented with a history of trauma, signs of pain of the hind quarters and anuria. Progression of the clinical signs, including anuria, lethargy, anorexia, and azotemia, prompted referral and investigation 108 hours following the initial injury. Retrograde urethrography indicated a rupture of the distal pelvic urethra with extravasation of urine subcutaneously. Development of extensive skin necrosis of the perineum and rump progressed leaving a large wound defect which was managed with wound debridement and dressing. The wound was closed using staged caudal superficial epigastric skin flaps and perineal urethrostomy as part of the reconstruction.

Introduction The combination of lesions of the penile urethra and the corpus cavernosum is rare and is likely to worsen the immediate and long-term prognosis. Aim To assess the late effects of penile fractures complicated by urethral rupture treated by immediate surgical intervention. Methods Fourteen patients with concomitant urethral rupture were treated surgically at our center. Those patients were seen in the outpatient follow-up clinic and were re-evaluated. Main Outcome Measures Sexual Health Inventory for Men questionnaire, local examination, uroflowmetry and penile color Doppler ultrasound. Results The most common cause of penile fracture is sexual intercourse (50%). The site of tunical tear was in the proximal shaft of the penis in 3 patients (21%) and in the mid of the shaft in 11 patients (79%). Urethral injury was localized at the same level as the corpus cavernosum tear in all cases; and it was partial in 11 cases and complete in 3. Long-term follow-up (mean=90 months) was available for 12 patients; among whom there was no complications in 4 (33%), painful erection in 1 (8%), erectile dysfunction in 2 (17%), and palpable fibrous nodule in 5 (47%). All patients had a normal urinary flow except one who developed relative urethral narrowing that required regular dilatation for 1 month. Conclusions The urethral injury complicating penile fracture is often partial and localized at the level of the corpora cavenosa tear. Standard treatment consists of immediate surgical repair of both urethral and corporal ruptures with no harmful long-term sequelae on urethral and erectile function in most of patients. El-Assmy A, El-Tholoth HS, Mohsen T, and Ibrahiem EHI. Long-term outcome of surgical treatment of penile fracture complicated by urethral rupture.

POTENTIAL COMPLICATIONS Urethral rupture In some neglected cases, rupture of the urethra/penis may occur, with subcutaneous urine accumulation up to 8 cm deep extending cranially from the scrotum to the prepuce. After several days, large, sharply-demarcated areas of purple-discoloured skin develop along the ventrum overlying the subcutaneous urine accumulation. This discoloured skin becomes cold, and, with associated necrotic muscle, will slough after 10-14 days, if the animal survives the uraemic state and urinary back pressure/hydronephrosis. In such cases, even if tube cystotomy surgery is successful, considerable sloughing occurs. The multiloculated sonographic appearance of the subcutaneous swelling indicates that drainage through a single or multiple skin incisions would not readily occur.

Injuries of the lower urinary tract occur in patients with multiple injuries and trauma to the lower abdominal and pelvic region. Injuries of the male urethra including complete ruptures occur in 10% of pelvic fractures in males, while they are a rarity in females. Ruptures of the urinary bladder are either intra- or extraperitoneal. Ureteral injuries are relatively rare in blunt injuries and usually become manifest with infectious symptoms with a delay of days. Intraperitoneal ruptures of the urinary bladder always require urgent surgical repair while extraperitoneal ruptures can mostly be managed conservatively with catheter drainage of the bladder. In male patients with pelvic fractures any attempt of urethral catheterization which can otherwise make an urethral injury worse should be withheld until adequate urological examinations have led to the diagnosis or exclusion of urethral injury. The definitive surgical repair of a disruption of the male urethra should be undertaken with an interval of weeks to months. Long term sequelae of male urethral injury can be impotence and chronic stricture disease.

Summary This case report documents uroperitoneum due to bladder and pelvic urethral rupture in a 9 h old Standardbred colt born after severe dystocia. Three surgical procedures were required to manage rupture of the urinary bladder, urethral rupture, and ventral abdominal hernia with evisceration of a loop of jejunum. After 40 days of hospitalisation the colt was discharged without any further complication.

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

Summary Objective: To assess the management of traumatic urethral ruptures using a systematic attempt at urethral catheterisation. Methods: Eleven cats that had been diagnosed with a traumatic urethral rupture over a five- year period were included in this study. Rupture was assessed by positive-contrast retrograde urethrography. An attempt was made to manage these ruptures by placing an indwelling urethral catheter. Results: The placement of an indwelling urethral catheter, could be performed in 10 out of 11 cats, which indicated a partial rupture. In one cat, catheterisation was not possible because of complete urethral rupture. A urethral catheter was placed into the urinary bladder via the urethra in five animals. In the other five animals, urethral catheterization required cystotomyusing a modified ‘inside to outside’ technique. Urethral catheter removal occurred between five and 14 days after placement. Urethral healing was accomplished in all cases of catheterisation with a good outcome in eight of the 10 cats. Two cats showed clinical signs related to stricture formation during the follow-up period (seven to 72 months). Retrograde urethrography provided a definitive diagnosis of partial rupture in only six of the 10 cases of partial rupture. Clinical significance: Results suggested that primary alignment with the placement of a urethral catheter should be attempted for the management of traumatic urethral ruptures in cats. Gentle urethral catheterisation seems to be an effective procedure for diagnosing and dealing with partial urethral rupture in cats. Clinical stricture formation can occur, but the risk does not seem to be high. Further studies are warranted in order to define the ideal duration for maintenance of an indwelling urethral catheter in cases of traumatic partial urethral rupture.

In this prospective study, we studied the role of ultrasonography (US) in the diagnosis and management of penile trauma.Between 2007 and 2014, 14 patients (mean age 39 years) with suspected penile fracture underwent US examinations. Almost all patients had a history of injury during sexual intercourse or manipulation of the penis. US examinations were performed in transversal and longitudinal planes starting at the level of the glans and moving down to the base of the penis. Color-Doppler was used to identify the vascular pattern or to see any abnormal vascularity.The most common blunt injury to the penis that occurred in nine patients was penile fracture due to rupture of the corpus cavernosum. A tear occurred in only one of the corpora cavernosa. US showed an irregular hypoechoic or hyperechoic defect at the cavernosal rupture site. Four patients presented an injury to the subtunical venous plexus in the absence of complete tunical disruption. One patient had urethral rupture with inability to urinate and apparent urethrorrhagia. Ten patients underwent surgical operation, while four patients were observed and discharged after 2 days. Mean follow-up was 32 months (range 3-58). After 8 to 12 weeks, all of them were able to be sexually active as before. Angulations of penis persisted in one patient.US may be the preferred imaging technique for evaluation of penile fracture before surgery. It is easy to perform, non-invasive, widely available, and inexpensive, although it requires an experienced team.In questo studio prospettico abbiamo analizzato il ruolo dell’imaging ecografico nella diagnosi e gestione del trauma penieno.Tra il 2007 ed il 2014, 14 pazienti (età media: 39 anni) con sospetto di frattura del pene furono sottoposti ad uno studio ecografico. Quasi tutti i pazienti presentavano un riscontro anamnestico di traumi avvenuti durante un rapporto sessuale o manipolazione del pene. Gli esami ecografici furono eseguiti facendo scansioni su piani trasversali e longitudinali iniziando a livello del glande e procedendo sino alla base dell’asta. L’utilizzo del Color-Doppler è stato adoperato per visualizzare l’assetto vascolare o per identificare qualsiasi forma di anomalia vascolare.La più comune forma di rottura traumatica del pene accorsa in 9 persone fu quella del corpo cavernoso. la rottura si verificò sempre a livello di un singolo corpo cavernoso. Lo studio ultrasonografico identificò il punto di rottura a livello del corpo cavernoso attraverso la visualizzazione di un irregolare stria ipoecogena o iperecogena. 4 pazienti presentarono una lesione del plesso venoso al di sotto della tunica albuginea senza rottura della stessa. Un solo paziente riportò un trauma dell’uretra presentando difficoltà alla minzione ed uretrorragia. 10 pazienti furono sottoposti ad intervento chirurgico, mentre gli altri 4 furono ricoverati in regime di osservazione e dimessi due giorni dopo. Il follow-up medio è stato di 32 mesi (range 3-58). Dopo circa 8-12 settimane tutti i pazienti ripresero la propria attività sessuale. In un solo paziente permase una deviazione permanente dell’asta.Secondo la nostra opinione l’esame ecografico può essere considerato la tecnica d’imaging da preferire nella valutazione di una rottura peniena prima d’intraprendere un approccio chirurgico. E’ semplce da eseguire, poco invasiva, ampiamente disponibile e poco costosa; anche se richiede operatori esperti.

The combination of lesions of the penile urethra and the corpus cavernosum is rare and likely to go unremarked. It worsens the immediate and long-term prognosis and poses a problem of management. Among 312 cases of penile fracture, we performed a retrospective study of a series of 10-case of traumatic corpora cavernosa rupture complicated with urethral rupture, treated in the department of Urology at 'Charles Nicolle' Hospital in Tunis. The median patients' age was 30 years. The most common mechanism was manipulation of an erect penis, found in six cases. Urethral rupture was suspected in all patients given the presence of bloody urethral discharge. No preoperative radiographic investigations were necessary. All patients underwent immediate surgical exploration. The urethral injury was always partial and localized at the level of the corpora tear. Surgical repair of both urethral and corpora tear was done in all patients. The follow up was uneventful. Urethrography at the removal of the transurethral catheter did not visualize contrast extravasation in any patient. No urethral stricture or erectile complaints were noted within a 36-month mean follow-up. Urethral rupture must be suspected in any case of penile fracture presenting with bloody urethral discharge. Standard treatment is immediate surgical repair.

Fracture of the penis, or rupture of the corpus c avernosum is an uncommon injury, but probably under-reported entity. Only approximately 180 cases have been reported in the literature. Penile N fracture with urethral injury is even more uncommon, accounting for approximately 10 to 20% of the cases reported. Early reports on this injury suggest conservative therapy as the choice of treatment. Recent reports emphasize immediate surgical repair to prevent late sequelae of injury, especially those associated with urethral rupture. We review 5 cases with evaluation, treatment and follow-up. Delays in treatment lead to long-term complications. .

Objective: To present the management of a patient with partial disruption of both cavernosal bodies and complete urethral rupture and to propose a non-systematic review of literature about complete urethral rupture. Material and method - Case report: A 46 years old man presented to our emergency department after a blunt injury of the penis during sexual intercourse. On physical examination there was subcutaneous hematoma extending over the proximal penile shaft with a dorsal-left sided deviation of the penis and urethral bleeding. Ultrasound investigation showed an hematoma in the ventral shaft of the penis with a discontinuity of the tunica albuginea of the right cavernosal corporum. The patient underwent immediate emergency surgery consisted on evacuation of the hematoma, reparation the partial defect of both two cavernosal bodies and end to end suture of the urethra that resulted completely disrupted. Results: The urethral catheter was removed at the 12-th postoperative day without voiding symptoms after a retrograde urethrography. 6 months postoperatively the patients was evaluated with uroflowmetry demonstrating a max flow rate of 22 ml/s and optimal functional outcomes evaluated with validated questionnaires. 8 months after surgery the patients was evaluated by dynamic magnetic resonance (MRI) of the penis showing only a little curvature on the left side of the penile shaft. Conclusion: Penile fracture is an extremely uncommon urologic injury with approximately 1331 reported cases in the literature till the years 2001. To best of our knowledge from 2001 up today, 1839 more cases have been reported, only in 159 of them anterior urethral rupture was associated and in only 22 cases a complete urethral rupture was described. In our opinion, in order to prevent long term complications, in case of clinical suspicion of penile fracture, especially if it is associated to urethral disruption, emergency surgery should be the first choice of treatment.

Diagnostic imaging is routinely performed in small animals with lower urinary tract disease. Survey radiographs allow identification of radiopaque calculi, gas within the urinary tract, and lymph node or bone metastases. Cystography and urethrography remain useful in the evaluation of bladder or urethral rupture, abnormal communication with other organs, and lesions of the pelvic or penile urethra. Ultrasonography is the modality of choice for the diagnosis of most disorders. Computed tomography and magnetic resonance imaging are useful in evaluating the ureterovesical junction and intrapelvic lesions, monitoring the size of lesions, and evaluating lymph nodes and osseous structures for metastases.

We investigated urethral diametric strain and threshold maximum inflation pressure for rupture during inadvertent inflation of a catheter anchoring balloon in the urethra. In addition, we evaluated a novel safety device to prevent trauma based on these parameters.Inflation of a urethral catheter anchoring balloon was performed in the bulbar urethra of 21 ex vivo porcine models using 16Fr catheters. Urethral trauma was assessed with retrograde urethrography. Urethral rupture was correlated with internal urethral diametric strain and maximal urethral pressure threshold values in kPa. Urethral catheters were then inflated in the bulbar urethras of 7 fresh male cadavers using a standard syringe and a prototype syringe. The plunger of the standard syringe was depressed until opposing resistance pressure generated by the urethra prevented further inflation of the anchoring balloon. The plunger of the prototype safety syringe was depressed until sterile water in the syringe decanted through an activated safety threshold pressure valve.Retrograde urethrography demonstrated that porcine urethral rupture consistently occurred at an internal urethral diametric strain greater than 40% and a maximum inflation pressure greater than 150 kPa. The mean ± SD maximum human urethral threshold inflation pressure required to activate the safety prototype syringe pressure valve was 153 ± 3 kPa. In comparison, maximum inflation pressure was significantly greater using the standard syringe than the activated prototype syringe (mean 452 ± 188 kPa, p0.001).Internal urethral diametric strain and threshold maximum inflation pressures are important parameters for designing a safer urethral catheter system with lower intrinsic threshold inflation pressures.

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 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.

Fracture of the penis is an uncommon pathology. It consists in a rupture of the tunica albuginea of one or both corpora cavernosa following injury to an erect penis. The most common causes are blunt trauma during sexual intercourse, masturbation, unconscious nocturnal penile manipulation or a fall onto the erect penis. The reason why rupture of the albuginea occurs only during erection lies in the fact that in the normal flaccid condition the penis occupies a position which is well protected against blows or blunt traumas. In the erect penis the tunica albuginea thins from 2 mm to 0.5 0.25 mm and thus it is more susceptible to traumatic tearing. Penile fracture associated with urethral injury is even more uncommon and accounts for 10 to 20% of reported cases. Prompt diagnosis and immediate surgical repair allows for earlier resumption of sexual activity and gives a lower incidence of penile chordee secondary to blood clot absorption and fibrous tissue formation. Surgery is mandatory for the prevention of late sequelae following injury especially in cases associated with urethral rupture. At times the corporeal tear is very large and in patients with concomitant lesions involving the urethra surgical repair can become difficult and require particular technical shrewdness. We report the surgical repair of 8 cases of penile fracture, two of which were complex involving both corpora cavernosa and an associated partial rupture of the urethra.

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.

Introduction: The optimal management strategy for urethral injuries remains controversial. Suprapubic cystostomy followed by delayed urethral reconstruction or immediate primary urethral injury repair is associated with high complication rate. Early endoscopic realignment for urethral injuries provides early definitive procedure with low complications and avoids the need for further urethral reconstruction. Materials and Methods: Between April 2007 and March 2016, 27 patients with traumatic posterior urethral disruptions were reviewed. All patients were managed by endoscopic urethral realignment. Patients were followed up every 3 months for 18–36 months regarding incontinence, potency, and urine flow. Results: Endoscopic urethral realignment was performed immediately in 21 patients and was delayed in 6 patients. It was successful in 24/27 (88.8%) patients. During the procedure, the proximal urethral end was identified directly in four patients, and by the guidance of methylene blue injection, guidewire or endoscopic light in three, nine, and eight patients, respectively. The Foley catheter was removed after 9 weeks in 17/24 (70.8%) patients and after 12 weeks in 7/24 (29.2%) patients. Six months after realignment, minimal urethral stricture was developed in 4/24 (16.7%) patients. All of them were treated successfully with single session of internal urethrotomy without recurrence after 1-year follow-up. After 18–36-month follow-up period, all patients were potent, continent, and with satisfactory voiding pattern. Conclusions: Endoscopic primary realignment of posterior urethral rupture is less invasive and a safer procedure, without pelvic hemorrhage or additional injuries. It has low incidence of severe urethral stricture and avoids the need for delayed open urethral reconstruction.

Pelvic fracture associated urethral injury (PFAUI) is a rare and challenging sequel of blunt pelvic trauma. Treatment of iatrogenic false urethral passage (FUP) remains as a challenge for urologists. In this case report we reviewed the iatrogenic FUP caused by wrong procedures performed in the treatment of a patient with PFAUI and the treatment of posterior urethral stricture with transperineal bulbo-prostatic anatomic urethroplasty in the management of FUP. A 37-year-old male patient with PFAUI had undergone a laparotomy procedure for pelvic bone fracture, complete urethral rupture, and bladder perforation 8 years ago. After stricture formation, patient had undergone procedures that caused FUP. Following operations, he had a low urinary flow rate, and incontinence and urgency even with small amounts of urine. FUP was diagnosed by voiding cystourethrography and retrograde urethrography. FUP was fixed with open urethroplasty with the guidance of flexible antegrade urethtoscopy. False passage should always be taken into account in the differential diagnosis of patients with persistent symptoms that underwent PFAUI therapy. In addition, we believe that in the evaluation of patients with PFAUI suspected for having a false passage, bladder neck and urethra should be assessed by combining routine voiding cystourethrography and retrograde urethrography with preoperative flexible cystoscopy via suprapubic route.

We describe the case of a 34-year-old patient, polytraumatized during a motorcycle accident. The patient reported complete urethral rupture, bilateral avulsion of the testes by the scrotum, subtotal avulsion with complete amputation of the corpora cavernosa, and a deep open perineal wound. The reconstruction, performed by urologists, was postponed to the following day to ensure high standard of treatment with appropriate tools. This choice has yielded a good aesthetic and functional result.