Repair of bulbous urethra injury

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 1. Closed urethral injury for more than 72h, open injury for more than 24h. Due to local tissue edema, congestion, urethral repair and anastomosis should not be performed, only suprapubic vesic stoma and extravasational extravasation can be performed. 2. Ball urethral injury combined with other life-threatening tissue and organ damage, the patient is seriously injured, and other life-threatening injuries should be treated first. In patients with unstable injuries, no urethral repair and anastomosis is performed, and only suprapubic bladder ostomy is performed. 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prevent urinary extravasation and reduce the patient's pain, bladder puncture can be performed first, and urine can be withdrawn.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. Position: The position of the stone. 2. Incision: perineal arc-shaped incision, direct to the perineal superficial fascia. 3. Reveal the urethral rupture: cut the deep fascia and the corpus cavernosum muscle in the longitudinal line to remove the hematoma and reveal the corpus cavernosum. A thicker catheter or metal probe is inserted from the urethral opening to expose it to the damaged area, revealing a urethral breach. The urethral sponge is separated under the penile fascia, the wound edge is trimmed, and the non-viable tissue is removed. 4. Find the proximal urethra: squeeze the bladder on the pubic bone. The place where the urine flows out in the wound area is the part of the proximal end of the urethra. It can be inserted by a catheter. If you still can't insert, you should cut the bladder on the pubis for the teacher's surgery. Use a metal probe to reach the bladder neck through the bladder neck and expose the proximal end of the urethra. 5. Insert the catheter, anastomosis of the urethra: Insert the 18- to 20-gauge balloon catheter from the urethra to the distal end of the urethra, and then insert the proximal end into the bladder. The capsule is filled with 15ml of sterile saline to avoid prolapse. Use 3% chrome gut for the full-thickness suture of the urethra; suture the posterior wall, then suture the anterior wall, and tie the knot outside, a total of 5-6 needles. If there is a lot of bleeding in the corpus cavernosum, you can do a full-thickness suture. 6. Stitching: The ball sponge muscle was sutured with a 2-0 silk thread, and the wound was placed with a rubber sheet to suture the perineal incision. 7. Drainage of the urine: the bladder is not cut, the balloon catheter is indwelled to prevent prolapse; the bladder incision, in addition to the urethra indwelling catheter, the bladder is placed in the bladder, and the two tubes are connected by wires. A cigarette is drained from the posterior pubic space.