UROLOGICAL TRAUMA

UROLOGICAL UROLOGICAL TRAUMATRAUMA

RENAL TRAUMARENAL TRAUMA

BackgroundBackground Renal trauma occurs in approximately 1-Renal trauma occurs in approximately 1-

5% of all traumas.5% of all traumas. Renal injuries are the most common Renal injuries are the most common

injuries of the urinary system.injuries of the urinary system. Blunt trauma directly to the abdomen, Blunt trauma directly to the abdomen,

flank, or back is the most common flank, or back is the most common mechanism, accounting for 80-85% of all mechanism, accounting for 80-85% of all renal injuries. renal injuries.

The kidney is well protected by heavy The kidney is well protected by heavy lumbar muscles, vertebral bodies, ribs, lumbar muscles, vertebral bodies, ribs, and the viscera anteriorly. and the viscera anteriorly.

Kidneys with existing pathologic Kidneys with existing pathologic conditions such as hydronephrosis or conditions such as hydronephrosis or malignant tumors are more readily malignant tumors are more readily ruptured from mild trauma.ruptured from mild trauma.

EthiologyEthiology

Trauma may result from motor Trauma may result from motor vehicle accidents, fights, falls, and vehicle accidents, fights, falls, and contact sports. Vehicle collisions at contact sports. Vehicle collisions at high speed may result in major renal high speed may result in major renal trauma from rapid deceleration and trauma from rapid deceleration and cause major vascular injury.cause major vascular injury.

Fractured ribs and transverse Fractured ribs and transverse vertebral processes may penetrate vertebral processes may penetrate the renal parenchyma or the renal parenchyma or vasculature.vasculature.

Gun-shot and knife wounds cause Gun-shot and knife wounds cause most penetrating injuries to the most penetrating injuries to the kidney; any such wound in the flank kidney; any such wound in the flank area should be regarded as a cause area should be regarded as a cause of renal injury until proved otherwise.of renal injury until proved otherwise.

Associated abdominal visceral Associated abdominal visceral injuries are present in 80% of renal injuries are present in 80% of renal penetrating wounds.penetrating wounds.

ClassificationClassification

ClassificationClassification Minor renal trauma Minor renal trauma (85% of cases)-(85% of cases)-

RenalRenal contusion or bruising of the contusion or bruising of the parenchyma is the most common parenchyma is the most common lesion. Subcapsular hematoma in lesion. Subcapsular hematoma in association with contusion is also noted. association with contusion is also noted. Superficial cortical lacerations are also Superficial cortical lacerations are also considered minor trauma. These injuries considered minor trauma. These injuries rarely require surgical exploration.rarely require surgical exploration.

Major renal trauma Major renal trauma (15% of cases)-(15% of cases)-Deep corticomedullary lacerations may Deep corticomedullary lacerations may extend into the collecting system, extend into the collecting system, resulting in extravasation of urine into resulting in extravasation of urine into the perirenal space. Large the perirenal space. Large retroperitoneal and perinephric retroperitoneal and perinephric hematomas often accompany these hematomas often accompany these deep lacerations. Multiple lacerations deep lacerations. Multiple lacerations may cause complete destruction of the may cause complete destruction of the kidney. Laceration of the renal pelvis kidney. Laceration of the renal pelvis without parenchymal laceration from without parenchymal laceration from blunt trauma is rare.blunt trauma is rare.


Vascular injury Vascular injury (about 1% (about 1% of all blunt trauma cases)of all blunt trauma cases)

Vascular injury of the renal Vascular injury of the renal pedicle is rare but may occur, pedicle is rare but may occur, usually from blunt trauma.usually from blunt trauma.

There may be total avulsion There may be total avulsion of the artery and vein or of the artery and vein or partial avulsion of the partial avulsion of the segmental branches of these segmental branches of these vessels. vessels.

Vascular injuries are difficult Vascular injuries are difficult to diagnose and result in total to diagnose and result in total destruction of the kidney destruction of the kidney unless the diagnosis is made unless the diagnosis is made promptly.promptly.

Clinical FindingsClinical Findings

The clinic of the closed damage of The clinic of the closed damage of kidney depends on its degree.kidney depends on its degree.

Each kind of trauma is Each kind of trauma is accompanied by characteristic accompanied by characteristic manifestations and general signs, manifestations and general signs, which are pain and intumescence in which are pain and intumescence in lumbar region, haematuria. lumbar region, haematuria.

Clinical FindingsClinical Findings SymptomsSymptoms:: Pain in lumbar region on the side of Pain in lumbar region on the side of

damage is observed in 80- 95 % of damage is observed in 80- 95 % of cases of isolated traumas of kidney cases of isolated traumas of kidney and in 10-20 % of combined injuries. and in 10-20 % of combined injuries. It is dull or acute with irradiation in It is dull or acute with irradiation in inguinal region or external sexual inguinal region or external sexual organs.organs.

Associated injuries such as ruptured Associated injuries such as ruptured abdominal viscera or multiple pelvic abdominal viscera or multiple pelvic fractures also cause acute fractures also cause acute abdominal pain and may obscure abdominal pain and may obscure the presence of renal injury.the presence of renal injury.

Catheterization usually reveals Catheterization usually reveals hematuria. hematuria.

Retroperitoneal bleeding may cause Retroperitoneal bleeding may cause abdominal distention, ileus, nausea abdominal distention, ileus, nausea and vomiting.and vomiting.

Clinical FindingsClinical Findings Signs:Signs: Initially, shock or signs of a large loss of blood from heavy Initially, shock or signs of a large loss of blood from heavy

retroperitoneal bleeding may be noted. Ecchymosis in the flank or retroperitoneal bleeding may be noted. Ecchymosis in the flank or upper quadrants of the abdomen is often noted. upper quadrants of the abdomen is often noted.

Lower rib fractures are frequently found. Lower rib fractures are frequently found. Diffuse abdominal tenderness may be found on palpation; an Diffuse abdominal tenderness may be found on palpation; an

"acute abdomen" indicates free blood in the peritoneal cavity. "acute abdomen" indicates free blood in the peritoneal cavity. A palpable mass may represent a large retroperitoneal hematoma A palpable mass may represent a large retroperitoneal hematoma

or perhaps urinary extravasation. If the retroperitoneum has been or perhaps urinary extravasation. If the retroperitoneum has been torn, free blood may be noted in the peritoneal cavity but no torn, free blood may be noted in the peritoneal cavity but no palpable mass will be evident. palpable mass will be evident.

The abdomen may be distended and bowel sounds absent.The abdomen may be distended and bowel sounds absent.

DiagnosticsDiagnostics

Diagnostics of the isolated closed Diagnostics of the isolated closed renal damage is not difficult in renal damage is not difficult in general.general.

The anamneses, presence of The anamneses, presence of trauma signs and hemorrhagies, trauma signs and hemorrhagies, pain in lumbar region, positive pain in lumbar region, positive Pasternatsky’s symptom testify Pasternatsky’s symptom testify probability of renal trauma. probability of renal trauma.

DiagnosticsDiagnostics

Laboratory FindingsLaboratory Findings::

Microscopic or gross hematuria is usually Microscopic or gross hematuria is usually present. present.

The hematocrit may be normal initially, The hematocrit may be normal initially, but a drop may be found when serial but a drop may be found when serial studies are done. This finding represents studies are done. This finding represents persistent retroperitoneal bleeding and persistent retroperitoneal bleeding and development of a large retroperitoneal development of a large retroperitoneal hematoma. hematoma.

Persistent bleeding may necessitate Persistent bleeding may necessitate operation.operation.

Diagnostics: Diagnostics: ChromocystoscopiaChromocystoscopia

Chromocystoscopy, if possible, also Chromocystoscopy, if possible, also helps to establish the correct diagnosis.helps to establish the correct diagnosis.

This method of research sometimes This method of research sometimes allows to find a location of bleeding allows to find a location of bleeding (that it is very important in case of (that it is very important in case of combined trauma), to analyse functions combined trauma), to analyse functions of damaged and opposite kidney, state of damaged and opposite kidney, state of urinary bladder wall.of urinary bladder wall.

However for a choice of method of However for a choice of method of treatment it is necessary to know the treatment it is necessary to know the character of damage and its character of damage and its localization. localization.

X-Ray FindingsX-Ray Findings

Observing radiographyObserving radiography (KUB): (KUB): tthe method allows to find he method allows to find damage of bones, to suspect damage of bones, to suspect presence of retroperitoneal presence of retroperitoneal hematoma (contours of kidney hematoma (contours of kidney and lumbar muscles are absent).and lumbar muscles are absent).

Excretory urographyExcretory urography gives an gives an opportunity to define the side of opportunity to define the side of damage, anatomical and function damage, anatomical and function status of injured and opposite status of injured and opposite

kidneykidney..


X-ray signs of renal damage are X-ray signs of renal damage are weak and later spreading of X-ray weak and later spreading of X-ray contrast solution in calyces-contrast solution in calyces-bowling systems, bowling systems, subcapsular and retrorenal spreading of X-ray and retrorenal spreading of X-ray contrast, deformation of renal contrast, deformation of renal bowl and calyces. bowl and calyces.

..


On angiogramms one can see violation of arterial and On angiogramms one can see violation of arterial and venous circulation attached to marginal injuries, filling of venous circulation attached to marginal injuries, filling of pararenal tissue with X-ray contrast due to injuries of renal pararenal tissue with X-ray contrast due to injuries of renal artery branches.artery branches.

Ultrasonography Ultrasonography

Ultrasound scans can detect renal Ultrasound scans can detect renal lacerations but cannot definitely assess lacerations but cannot definitely assess their depth and extent. In addition, they their depth and extent. In addition, they do not provide functional information. do not provide functional information.

During the evaluation of blunt trauma During the evaluation of blunt trauma patients, ultrasound scans were more patients, ultrasound scans were more sensitive and specific than intravenous sensitive and specific than intravenous pyelography (IVP) in minor renal trauma. pyelography (IVP) in minor renal trauma.

Another possible role for ultrasound may Another possible role for ultrasound may be for serially evaluating stable renal be for serially evaluating stable renal injuries for the resolution of urinomas and injuries for the resolution of urinomas and retroperitoneal haematomas.retroperitoneal haematomas.

Computed tomography (CT)Computed tomography (CT) Staging begins with an Staging begins with an

abdominal CT scan, the most abdominal CT scan, the most direct and effective means of direct and effective means of staging renal injuries.staging renal injuries.

This noninvasive technique This noninvasive technique

clearly defines parenchymal clearly defines parenchymal lacerations and urinary lacerations and urinary extravasation, shows the extravasation, shows the extent of the retroperitoneal extent of the retroperitoneal hematoma, identifies hematoma, identifies nonviable tissue, and outlines nonviable tissue, and outlines injuries to surrounding organs injuries to surrounding organs such as the pancreas, spleen, such as the pancreas, spleen, liver, and bowel. liver, and bowel.

T R E A T M E N TT R E A T M E N T

The treatment can be The treatment can be conservative and conservative and operational. operational.

The majority of the The majority of the experts choose tactic of experts choose tactic of expectation. expectation.


Bed regimen is provided within 10-20 day.Bed regimen is provided within 10-20 day.

Measures to stop bleeding (administration of Measures to stop bleeding (administration of haemostatic agents, hemo- and haemostatic agents, hemo- and plasmotransfusion), administration of plasmotransfusion), administration of analgetics, antibiotics of a wide spectrum of analgetics, antibiotics of a wide spectrum of action, and also dynamical overseeing by action, and also dynamical overseeing by arterial pressure. arterial pressure.

Antibiotics are used for pyelonephritis Antibiotics are used for pyelonephritis prophylactics.prophylactics.


Indications to Indications to operative treatmentoperative treatment: :

аа) internal bleedings in case ) internal bleedings in case of isolated renal damage, of isolated renal damage, which are accompanied by an which are accompanied by an anaemia, decrease of arterial anaemia, decrease of arterial pressure, fast pulse;pressure, fast pulse;

b) hematuria within a day b) hematuria within a day with worsening of general with worsening of general state of the patient; state of the patient;

c) hematoma in lumbar c) hematoma in lumbar region, which is slowly region, which is slowly growing; growing;

d) combination of renal d) combination of renal damage and organs of damage and organs of abdominal cavity or thorax.abdominal cavity or thorax.

TREATMENTTREATMENT

The operation should be maximum savings and directed on the The operation should be maximum savings and directed on the decision of two tasks - stopping of bleeding and normalization of decision of two tasks - stopping of bleeding and normalization of urine outflow. urine outflow.

INJURIES OF THE URINARY BLADDERINJURIES OF THE URINARY BLADDER

Bladder injuries occur most often from external force and are often Bladder injuries occur most often from external force and are often associated with pelvic fractures. (About 15% of all pelvic fractures are associated with pelvic fractures. (About 15% of all pelvic fractures are associated with concomitant bladder or urethral injuries.) associated with concomitant bladder or urethral injuries.)

Iatrogenic injury may result from gynecologic and other extensive Iatrogenic injury may result from gynecologic and other extensive pelvic procedures as well as from hernia repairs and transurethral pelvic procedures as well as from hernia repairs and transurethral operations.operations.


closed and openclosed and open isolated and combinedisolated and combined intraperitoneal, intraperitoneal,

retroperitoneal and mixed. retroperitoneal and mixed.


Symptoms:Symptoms:

There is usually a history of lower abdominal trauma.There is usually a history of lower abdominal trauma. Blunt injury is the usual cause. Blunt injury is the usual cause. Patients ordinarily are unable to urinate, but when Patients ordinarily are unable to urinate, but when

spontaneous voiding occurs, gross hematuria is usually spontaneous voiding occurs, gross hematuria is usually present. present.

Most patients complain of pelvic or lower abdominal Most patients complain of pelvic or lower abdominal painpain..


Signs:Signs: Heavy bleeding associated with pelvic fracture Heavy bleeding associated with pelvic fracture

may result in hemorrhagic shock, usually from may result in hemorrhagic shock, usually from venous disruption of pelvic vessels.venous disruption of pelvic vessels.

An acute abdomen indicates intraperitoneal An acute abdomen indicates intraperitoneal bladder rupture. bladder rupture.

A palpable mass in the lower abdomen usually A palpable mass in the lower abdomen usually represents a large pelvic hematoma.represents a large pelvic hematoma.

On rectal examination, landmarks may be On rectal examination, landmarks may be indistinct because of a large pelvic hematoma.indistinct because of a large pelvic hematoma.


Laboratory FindingsLaboratory Findings:: Catheterization usually is required in Catheterization usually is required in

patients with pelvic trauma but not if patients with pelvic trauma but not if bloody urethral discharge is noted. bloody urethral discharge is noted.

When catheterization is done, gross or, When catheterization is done, gross or, less commonly, microscopic hematuria is less commonly, microscopic hematuria is usually present.usually present.

Urine taken from the bladder at the Urine taken from the bladder at the initial catheterization should be cultured initial catheterization should be cultured to determine whether infection is to determine whether infection is present.present.


A plain abdominal film A plain abdominal film generally demonstrates pelvic generally demonstrates pelvic fractures. There may be fractures. There may be haziness over the lower haziness over the lower abdomen from blood and abdomen from blood and urine extravasation.urine extravasation.

An intravenous urogram An intravenous urogram should be obtained to should be obtained to establish whether kidney and establish whether kidney and ureteral injuries are present.ureteral injuries are present.


Bladder disruption is shown on Bladder disruption is shown on cystography.cystography.

Retrogradual cystography help to Retrogradual cystography help to differentiate penetrating and differentiate penetrating and unpenetrating, intraperitoneal and unpenetrating, intraperitoneal and retroperitoneal ruptures of the bladder, retroperitoneal ruptures of the bladder, locate urinary flow and approximate site locate urinary flow and approximate site of rupture.of rupture.

The sign of retroperitoneal rupture is The sign of retroperitoneal rupture is accumulation of X-ray contrast matter accumulation of X-ray contrast matter in perivesical fat tissue.in perivesical fat tissue.

With intraperitoneal extravasation, free With intraperitoneal extravasation, free contrast medium is visualized in the contrast medium is visualized in the abdomen, highlighting bowel loops.abdomen, highlighting bowel loops.


TreatmentTreatment A.A. Emergency Measures: Emergency Measures: Shock and hemorrhage should be Shock and hemorrhage should be

treatedtreated..

B.B. Surgical Measures: Surgical Measures: A lower midline abdominal incision A lower midline abdominal incision

should be made. As the bladder is should be made. As the bladder is approached in the midline, a pelvic approached in the midline, a pelvic hematoma, which is usually lateral, hematoma, which is usually lateral, should be avoided. Entering the should be avoided. Entering the pelvic hematoma can result in pelvic hematoma can result in increased bleeding from release of increased bleeding from release of tamponade and in infection of the tamponade and in infection of the hematoma, with subsequent pelvic hematoma, with subsequent pelvic abscess. The bladder should be abscess. The bladder should be opened in the midline and carefully opened in the midline and carefully inspected. After repair, a inspected. After repair, a suprapubic cystostomy tube is suprapubic cystostomy tube is usually left in place to ensure usually left in place to ensure complete urinary drainage and complete urinary drainage and control of bleeding.control of bleeding.

TreatmentTreatment

In a case of retroperitoneal complete In a case of retroperitoneal complete rupture of the bladder it is exposed by rupture of the bladder it is exposed by suprapubic extraperitoneal access suprapubic extraperitoneal access carefully inspected and is juncture by carefully inspected and is juncture by two-row catgut junctures.two-row catgut junctures.

Drainage by means of epicystostomy Drainage by means of epicystostomy is necessary.is necessary.

Operation finish with drainage of Operation finish with drainage of perivesical and pelvic tissue.perivesical and pelvic tissue.

In order to prevent formation of In order to prevent formation of urinary flow, in all cases of urinary flow, in all cases of retroperitoneal rupture of urinary retroperitoneal rupture of urinary bladder, perivesical space is drainage bladder, perivesical space is drainage through obturatorial foramen or through obturatorial foramen or ischiorectal space. ischiorectal space.

TreatmentTreatment Intraperitoneal bladder ruptures should Intraperitoneal bladder ruptures should

be repaired via a transperitoneal be repaired via a transperitoneal approach after careful transvesical approach after careful transvesical inspection and closure of any other inspection and closure of any other perforations. perforations.

The peritoneum must be closed The peritoneum must be closed carefully over the area of injury.carefully over the area of injury.

The bladder is then closed in separate The bladder is then closed in separate layers by absorbable suture. layers by absorbable suture.

All extravasated fluid from the All extravasated fluid from the peritoneal cavity should be removed peritoneal cavity should be removed before closure.before closure.

At the time of closure, care should be At the time of closure, care should be taken that the suprapubic cystostomy taken that the suprapubic cystostomy is in the extraperitoneal position.is in the extraperitoneal position.

INJURIES Of THE URETHRAINJURIES Of THE URETHRA

Urethral injuries are uncommon and Urethral injuries are uncommon and occur most often in men, usually occur most often in men, usually associated with pelvic fractures or associated with pelvic fractures or straddle-type falls. straddle-type falls.

Various parts of the urethra may be Various parts of the urethra may be lacerated, transected, or contused. lacerated, transected, or contused.

Management varies according to the Management varies according to the level of injury. level of injury.

The urethra can be separated into 2 The urethra can be separated into 2 broad anatomic divisions: the broad anatomic divisions: the posterior urethra, consisting of the posterior urethra, consisting of the prostatic and membranous portions, prostatic and membranous portions, and the anterior urethra, consisting of and the anterior urethra, consisting of the bulbous and pendulous portionsthe bulbous and pendulous portions

Clinical FindingsClinical Findings Symptoms:Symptoms: Patients usually complain of lower abdominal pain and inability to Patients usually complain of lower abdominal pain and inability to

urinate. A history of crushing injury to the pelvis is usually obtained.urinate. A history of crushing injury to the pelvis is usually obtained. Signs:Signs: Blood at the urethral meatus is the single most important sign of Blood at the urethral meatus is the single most important sign of

urethral injury (urethral injury (UrethroragiaUrethroragia).). Suprapubic tenderness and the presence of pelvic fracture are noted Suprapubic tenderness and the presence of pelvic fracture are noted

on physical examination. on physical examination. A large developing pelvic hematoma may be palpated.A large developing pelvic hematoma may be palpated. Perineal or suprapubic contusions are often noted. Perineal or suprapubic contusions are often noted. Rectal examination may reveal a large pelvic hematoma with the Rectal examination may reveal a large pelvic hematoma with the

prostate displaced superiorly.prostate displaced superiorly.


Laboratory FindingsLaboratory Findings::

Anemia due to hemorrhage may be Anemia due to hemorrhage may be noted.noted.

Urine usually cannot be obtained Urine usually cannot be obtained initially, since the patient should not initially, since the patient should not void and catheterization should not void and catheterization should not

be attempted.be attempted.


Instrumental Examination:Instrumental Examination:

The only instrumentation involved The only instrumentation involved should be for urethrography.should be for urethrography.

Catheterization or urethroscopy Catheterization or urethroscopy should not be done, because should not be done, because these procedures pose an these procedures pose an increased risk of hematoma, increased risk of hematoma, infection, and further damage to infection, and further damage to partial urethral disruptions.partial urethral disruptions.


Fractures of the bony pelvis are Fractures of the bony pelvis are usually present. usually present.

A urethrogram (using 20-30 ml A urethrogram (using 20-30 ml of watersoluble contrast of watersoluble contrast material) shows the site of material) shows the site of extravasation.extravasation.

Ordinarily, there is free Ordinarily, there is free extravasation of contrast extravasation of contrast material into the perivesical material into the perivesical space.space.

Incomplete Incomplete prostatomembranous disruption prostatomembranous disruption is seen as minor extravasation, is seen as minor extravasation, with a portion of contrast with a portion of contrast material passing into the material passing into the prostatic urethra and bladder.prostatic urethra and bladder.


TreatmentTreatment

Conservative therapy is effective Conservative therapy is effective for patients with recent for patients with recent nonpenetrating damage of nonpenetrating damage of urethra: rest, cool compresses, urethra: rest, cool compresses, and antibiotics. and antibiotics.

Within 7-8 days after trauma Within 7-8 days after trauma thermal procedures and thermal procedures and resorption agents are prescribed. resorption agents are prescribed.

In case of ischuria instead of a In case of ischuria instead of a high cystotomy it is possible to high cystotomy it is possible to perform troacar epicystostomy.perform troacar epicystostomy.

Shock and hemorrhage should be Shock and hemorrhage should be treated.treated.

TreatmentTreatment

Surgical Measures:Surgical Measures: Urethral catheterization should Urethral catheterization should

be avoided.be avoided. InitialInitial management should management should

consist of suprapubic cystostomy consist of suprapubic cystostomy to provide urinary drainage.to provide urinary drainage.

A midline lower abdominal A midline lower abdominal incision should be made, care incision should be made, care being taken to avoid the large being taken to avoid the large pelvic hematoma. pelvic hematoma.

The bladder should be opened The bladder should be opened and carefully inspected for and carefully inspected for lacerations. If a laceration is lacerations. If a laceration is present, the bladder should be present, the bladder should be closed with absorbable suture closed with absorbable suture material and a cystostomy tube material and a cystostomy tube inserted for urinary drainage.inserted for urinary drainage.

The suprapubic cystostomy is The suprapubic cystostomy is maintained in place for about 3 maintained in place for about 3 months. This allows resolution of months. This allows resolution of the pelvic hematoma, and the the pelvic hematoma, and the prostate and bladder will slowly prostate and bladder will slowly return to their anatomic return to their anatomic positions.positions.

Film SFilm Suprapubic Cystostomyuprapubic Cystostomy

TreatmentTreatment

Urethral reconstruction -Urethral reconstruction -ReconstructionReconstruction of the urethra of the urethra after prostatic disruption can after prostatic disruption can be undertaken within 3 months.be undertaken within 3 months.

Before reconstruction, a Before reconstruction, a combined cystogram and combined cystogram and urethrogram should be done to urethrogram should be done to determine the exact length of determine the exact length of the resulting urethral stricture. the resulting urethral stricture.

The preferred approach is a The preferred approach is a single-stage reconstruction of single-stage reconstruction of the urethral rupture defect with the urethral rupture defect with direct excision of the strictured direct excision of the strictured area and anastomosis of the area and anastomosis of the bulbous urethra directly to the bulbous urethra directly to the apex of the prostate. apex of the prostate.

A 16F silicone urethral catheter A 16F silicone urethral catheter should be left in place along should be left in place along with a suprapubic cystostomy. with a suprapubic cystostomy.

Catheters are removed within a Catheters are removed within a month, and the patient is then month, and the patient is then able to voidable to void

Re-do end to endRe-do end to end

ComplicationsComplications

Stricture, impotence, and incontinence as complications of Stricture, impotence, and incontinence as complications of prostatomembranous disruption.prostatomembranous disruption.

Stricture following primary repair and anastomosis occurs in about Stricture following primary repair and anastomosis occurs in about one-half of cases. If the preferred suprapubic cystostomy approach one-half of cases. If the preferred suprapubic cystostomy approach with delayed repair is used, the incidence of stricture can be reduced with delayed repair is used, the incidence of stricture can be reduced to about 5%.to about 5%.

The incidence of impotence after primary repair is 30-80% (mean, The incidence of impotence after primary repair is 30-80% (mean, about 50%). Incontinence in primary reanastomosis is noted in one-about 50%). Incontinence in primary reanastomosis is noted in one-third of patients. third of patients.

Delayed reconstruction reduces the incidence to less than 5%.Delayed reconstruction reduces the incidence to less than 5%.

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UROLOGICAL TRAUMA