Urethral injuries尿路损伤.ppt

Urethral injuries Introduction Urological injuries occur in approximately 10% of patients who present following blunt or penetrating trauma Of these, a number involve the urethra:65% are complete and 35% partial Urethral injuries by themselves are never life-threatening, except. It is of no surprise that the highest incidence of urethral injuries is in adults aged 15-25 years. Urethral injuries can range from a mild contusion with preservation of epithelial continuity, to a partial tear of the urethral epithelium or a full urethral transection and disruption. They can also be classified by site into anterior urethral injuries and posterior urethral injuries, which is probably the best way to consider them, since both sites are exposed to different mechanisms of injury. Anatomy The male urethra is divided into the anterior and posterior sections by the so-called urogenital diaphragm. The posterior urethra consists of the prostatic and the membranous urethra The latter is enclosed in the urogenital diaphragm. It extends from the bladder neck to the distal sphincter mechanism for a length of 3 cm. The anterior urethra consists of the bulbar and penile urethra and is a 15 cm canal extending from the end of the membranous urethra to the external meatus. The bladder-neck sphincter is functional from the internal meatus doun to the level of the verumontanum, in males it is reliably comptent , provided it is notsurgically damaged or rendered incompetent by unstable detrusor contractions. The distal sphincter mechanism is about 2.5 cm long, but it is only 3-4 mm thick; it forms the whole thickness of the membranous urethra and extends upwards, through the apical prostatic capsule, to the verumontanum. The competence of this distal urethral mechanism is, in fact, entirely dependent on the sphincter muscles within the 3-4mm. Anterior urethral injuries Straddle injury Posterior urethral injuries Unfortunately, the term posterior urethral stricture’ is still w