Urological Emergencies in Clinical Practice стр.85

5. TRAUMATIC UROLOGICAL EMERGENCIES 113

a stricture does result, it is usually only 0.5 cm or so long and can be easily managed with optical urethrotomy or anastomotic urethroplasty.

Complete Rupture of Anterior Urethra

Where the anterior urethra has been completely torn across, then if the patient is unstable, as a consequence of other injuries, a suprapubic catheter can be placed and repair delayed until the patient has recovered from the other injuries.

If the patient is stable, the urethra may either be immediately repaired or a suprapubic catheter can be placed with delayed repair. Whether immediate repair is performed, as for partial ruptures, depends on the presence of a surgeon with sufficient experience in dealing with these injuries.

Penetrating Anterior Urethral Injuries

These are uncommon, and result from knife or gunshot wounds. They are generally managed by surgical debridement and repair (Gomez et al. 1993).

TESTICULAR INJURIES

Causes and Pathophysiology

The majority of testicular injuries in civilian practice are blunt injuries occurring during sports, motor vehicle accidents, or as a consequence of assaults. Very rarely these injuries are self-inflicted. The testicles are forced against the pubis or the thigh. Bleeding can occur into the parenchyma of the testis, and if the force is sufficient, the tunica albuginea of the testis, the tough fibrous coat surrounding the parenchyma, can rupture, allowing extrusion of seminiferous tubules.

Penetrating testicular injuries occur as a consequence of gunshot wounds, knife wounds, and from bomb blasts. Associated limb (e.g., femoral vessel), perineal (penis, urethra, rectum), pelvic, abdominal, and chest wounds may occur.

Where bleeding is confined by the parietal layer of the tunica vaginalis, a haematocele is said to exist (Fig. 5.24). Intra-parenchymal (intratesticular) haemorrhage and bleeding beneath the parietal layer of tunica vaginalis cause the testis to enlarge slightly. The seemingly minor degree of swelling hides the fact that such a testis may be under great pressure as a consequence of the intratesticular haemorrhage. This can subsequently lead to ischaemia, necrosis, and atrophy of the testis (McDermot and Gray 1989).


Предыдущая Следующая