Prostate tip-perineal 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. Treating diseases: prostate disease Indication Prostate urethral rupture, urinary genital warts are not destroyed, can be treated with prostate tip-perineal traction. This method is simple to operate, can close the two ends of the broken urethra, the effect is better than the urethral retraction, but still less than the urethral anastomosis. Surgical procedure The bladder is first exposed by the urethral retraction technique, and the balloon catheter is introduced into the bladder through the urethra, and then the prostate tip-perineal traction is performed as follows. 1. Expose the tip of the prostate, pass the bladder through the traction line and press the bladder back to the top to reveal the tip of the prostate behind the pubis. Use a 2-0 absorbable line to traverse the prostate under the neck of the bladder. Note that the needle thread should be sewed deeper and cannot be inserted into the urethral cavity. 2. Straight needle thread passes through the urogenital ridge to remove the rounded needle. The absorbable thread is threaded on the straight needle. The straight needle passes through the urogenital ridge on both sides of the distal end of the urethra and passes through the perineum. 3. Traction of the prostate in the perineum to tighten the suture, so that the prostate is close to the urogenital ridge, so that the two ends of the urethra meet. 4. Fix the traction line of the perineal pad with a small piece of gauze, the suture is knotted and fixed on the small gauze piece. 5. Perform a suprapubic bladder stoma, drain the rubber tube behind the pubis, and close the incision layer by layer.