Posterior urethral injury repair

The posterior urethra is ruptured and a posterior urethral anastomosis should be performed when the patient's condition permits. The surgical method is the same as the urethral injury repair, but the anterior branch of the vaginal center is separated from the urethral ball. The rectum is retracted and the prostate tip is separated. The front end of the prostate is completely transected, and the patient with posterior urethral rupture moving up the front end of the prostate, if the general condition is poor, can not tolerate more complicated surgery, and the posterior urethral traction repair is feasible. This kind of posterior urethral traction repair is actually a kind of surgery, and gravity traction is added after surgery. Treatment of diseases: urethral injury, hypospadias, urethra Indication 1. If the urethral injury is heavy and can not be placed into the catheter, urethral anastomosis (including ball urethral repair, posterior urethra repair) is required. 2. In patients with urethral injury and pelvic fracture, the lithotomy position can aggravate the fracture displacement, leading to serious complications, so urethral anastomosis should be avoided, and guinea or pubic bladder ostomy. 3. Patients with pelvic fractures, rectal rupture, severe shock, or vaginal bladder fistula, colostomy, and urethra repair. 4. Early open urethral bulb injury, when the defect is short, the urethral anastomosis can be performed; when the defect is long, the vaginal urethral ostomy should be performed. Contraindications The skin of the surgical site is infected; Patients with bleeding-prone diseases should pay attention. Preoperative preparation 1. Correct the shock before surgery. 2. Preoperative urinary retention with acute urinary retention, in order to prevent urinary extravasation and reduce the patient's pain, bladder puncture can be performed first, and urine can be withdrawn. Surgical procedure 1. Instructor: mid-abdominal incision in the lower abdomen, incision of the bladder according to bladder fistula, inserted into the urethral rupture from the external urethra with a metal catheter; then inserted into the bladder from the bladder incision with a metal probe, and the bladder neck to the urethra At the break, the division will introduce the metal catheter into the bladder. 2. The catheter is taken from the urethral orifice through the bladder: a 20 gauge rubber catheter is inserted from the bladder incision, and the metal catheter introduced into the bladder is ligated with a silk thread. Then, the metal catheter is withdrawn from the external urethra and the tip of the 20th catheter is taken out [Fig. 1 (1)]. 3. Introduce the balloon catheter into the bladder: connect the No. 20 catheter to the balloon catheter with a silk thread and withdraw the No. 20 catheter to bring the balloon catheter into the bladder [Fig. 1 (2)]. 15 ml of sterile saline was injected into the balloon to inflate it. The postoperative balloon catheter will be used for traction, while the 20th catheter will be used as a suprapubic bladder fistula. 4. Stitching: The bladder incision was sutured, the inner layer was sutured intermittently with 2-0 gut, and the outer layer was sutured with broken silk thread, and the suture did not penetrate the mucosa. Drainage of the perineal incision, repair of the contracted ball urethral injury. 5. Traction: Gravity traction of the balloon catheter after surgery, the weight starts at 0.5kg, traction for 3 days; later, 0.25kg traction for 3 days. The angle of traction of the catheter should be 45° to the trunk to avoid pressure-induced urethral compression necrosis. Traction should not be too heavy to avoid urinary incontinence. complication Stenosis, impotence, and urinary incontinence are the most serious complications of urethral injury in the prostatic membrane.