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TIP’s and TRICK’s in Straddle Injury

BAMBANG SASONGKO NOEGROHO


U R O LO G Y T R A I N I N G C E N T E R
M E D I C A L S C H O O L PA DJ A DJ A R A N U N I V E R S I T Y
H A S A N S A D I K I N G E N E R A L H O S P I TA L
BANDUNG
Straddle Injury
DEFINITION :
Injury to the distal urethra, by falling astride a blunt object,
such as bicycle handlebars or the top of a fence or railing
(Mosby Med Dict 9th ed.2009 Elsevier)

OR

Blunt trauma to the perineum, often with fracture of the pelvis


and genital and internal injuries (eg to the
penis,vagina,testes,bladder or uterus) (Medical Dict 2009 Farlex and Partners)
History
History
History
History
Presentation
• Physical examination :
1. Blood at the meatus
2. Palpable full bladder
3. High riding prostate gland upon DRE
4. Extravasation of blood along the fascial planes of
the perineum is another indication of injury to
the urethra
5. “Pie in the sky ” findings revealed by cystography
usually indicate urethral disruption
Meatal Bleeding
Perineal Hematoma
Diagnostic
•History
•Physical examination
•Urethrography (retrograde)
•Urethrocystography
Urethrography (retrograde)
Urethrography (retrograde)
Urethrocystography
Urethral Anterior Injuries
Management
• Meatal bleeding and urine retention,
consider to do Cystostomy -percutaneus
- open (in the
past)
• -Diagnostic :- partial : manage by PER
-complete : open surgery
• Antibiotic (empirical) prophylaxis
• Analgesics
Degree of Urethral Injury
Open Cystostomy
Open Cystostomy
(not recommended)
Primary Endoscopic Realignment
(PER)
Primary Endoscopic Realignment
(PER)
Primary Endoscopic Realignment
(PER)
Primary Endoscopic Realignment
(PER)
Open Surgery
Complete Anterior Urethral section
Open Surgery Repair
Complications of Anterior
Urethral Injury
• EARLY
Complete rupture-subcutan extravasation of
urine occurs if patient attempt to pass urine
• LATE
Infection
Stricture is a common sequel in partial or
complete tear, periurethral bruising
Take Home Message
• Cystostomy (Percutaneous) the most
common useful for initial procedure of Urine
Retention due to urethral injury
(Laceration,Partial or Total rupture )
• Foley cath 16 F 2 way is the best for
cystostomy (at least 14 F)
• Only two ways for repairing urethral injury,
PER or Open surgery
Thank You