urethral rendezvous traction

Posterior urethral injury is more common in pelvic fractures, most commonly in pelvic crush injuries caused by traffic accidents, house collapse, mine collapse. The urethra of the membrane passes through the urogenital ridge and is fixed by it. The prostatic urethra is fixed to the lower part of the pubic symphysis by means of the pubic prostate ligament. When the pelvic fracture causes the anterior and posterior diameter of the pelvic ring to increase, the left and right diameters become smaller, or the anteroposterior diameter becomes smaller, and the left and right diameters increase, the pubis prostate ligament is severely but strongly pulled or itself torn, or suddenly displaced along with the prostate. , causing tear or breakage at the junction of the urethra and the membrane urethra of the prostate, or tearing or rupture due to tearing of the urogenital ridge and the urethra passing through the membrane. The urethra is less common after a direct puncture of the pelvic fracture. After posterior urethral injury, urinary extravasation first accumulates in the honeycomb tissue of the posterior pubic space. If further developed, the front can be spread along the extraperitoneal tissue, and the posterior can be spread along the retroperitoneal space. When the urogenital sputum is intact, the extravasation of urine can not enter the shallow pocket of the perineum. If it has been damaged, the extravasation of urine can also enter the perineum through the damage of the urogenital plaque. The injury of the posterior urethral injury is generally more serious than the urethral injury of the ball, and the incidence of shock is high. The main cause of shock is severe bleeding and extensive injury. Pelvic fractures, posterior urethral injury, and tears around the venous plexus and pelvic vascular injuries can cause massive internal bleeding. Internal hemorrhage can form a large hematoma around the bladder and the retroperitoneal space. Therefore, the treatment of posterior urethral injury is first of all to prevent and treat shock, and if necessary, transfusion. Posterior urethral injury often coincides with other organ damage, can not be missed, and should be based on the size of life threats, decide or treat the combined injury first, or treat the urethral injury first. The local treatment for posterior urethral injury is to first insert a F16-18 catheter under sterile operation. If the bladder can be inserted, the continuity of the posterior urethra is not completely destroyed, and it is left for about 3 weeks. After extubation, the urethral dilatation is performed regularly, and it can be cured. If the catheter cannot be inserted, the posterior urethra is completely broken or largely ruptured and should be treated surgically. The preoperative preparation of the posterior urethral injury surgery is the same as the urethral repair anastomosis. Pelvic X-rays should be used to observe pelvic fractures. If the condition allows or the child is injured, an intravenous urography should be performed to understand the bladder and upper urinary tract. Treatment of diseases: urethral injury Indication The operation of the urethral retractor is simple and the bleeding is less, but the urethral stump is not directly anastomosed. The fractured urethra is repositioned by traction, and the possibility of urethral stricture after healing is greater than that of urethral anastomosis. Applicable to those with serious injuries, or other organs combined with injuries, generally poor, can not tolerate more complicated surgical wounds, or medical conditions do not have post-operative urethral anastomosis. Surgical procedure 1. The urethral resection of the lower abdomen of the lower abdomen reveals the anterior wall of the bladder and the posterior pubic space, clears the hematoma and extravasation of urine, and stops bleeding. Cut the bladder and drain the urine. A metal catheter or urethral probe is inserted through the external urethra to the tip of the urethra. The surgeon uses the index finger to insert the posterior urethra and the urethra probe into the division through the bladder incision. Under the guidance of the index finger, the probe inserted from the outer urethra is introduced into the bladder. 2. The urethra is built into the balloon catheter on the urethral probe introduced into the bladder, and a common catheter is placed. Exit the urethral probe and let the catheter enter the urethra. A balloon catheter is then sewed at the end of the catheter and brought into the bladder. 3. Urethral traction with sterile isotonic saline 20 ~ 25ml inflated balloon, traction balloon catheter along the urethra direction, by the traction force to make the two ends of the urethra. 4. Place the rubber tube behind the pubis to drain, close the incision, and parallel the visceral bladder stoma. complication 1. If the postoperative urethral traction is too heavy or too long, the external urinary sphincter may be damaged, and temporary or permanent urinary incontinence may occur. If the direction of traction of the urethra is too low, it may cause compression and necrosis at the junction of the scrotum of the urethra. Urinary fistula or urethral stricture can be formed after secondary infection. 2. Some cases have urethral stricture and need to be treated again.