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Traumatic female urethral avulsion.

Al-Asbahi WA - Saudi Med J (2015)

Bottom Line: Traumatic female urethral avulsion in the absence of a pelvic fracture is an exceedingly rare entity, with no consensus on its' management.Here, we present a 35-year-old pregnant woman with severe anterior vaginal wall laceration and complete urethral avulsion secondary to straddle injury.Management consisted of primary urethral and vaginal repair.

View Article: PubMed Central - PubMed

Affiliation: Urology and Nephrology Center, Al-Thawra Modern General and Teaching Hospital, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. Tel. +967 (734) 929979. E-mail. walasbahi@hotmail.com.

ABSTRACT
Traumatic female urethral avulsion in the absence of a pelvic fracture is an exceedingly rare entity, with no consensus on its' management. Here, we present a 35-year-old pregnant woman with severe anterior vaginal wall laceration and complete urethral avulsion secondary to straddle injury. Management consisted of primary urethral and vaginal repair.

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Severe laceration of the anterior vaginal wall with complete urethral avulsion; with the catheter passed through the avulsed distal segment.
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Figure 1: Severe laceration of the anterior vaginal wall with complete urethral avulsion; with the catheter passed through the avulsed distal segment.

Mentions: A 35-year-old woman in the sixth month of pregnancy, presented to the emergency department post fall down straddle injury onto a sharp object (rock), during her work as a farmer. Her injuries involved the genitalia. There was profuse vaginal bleeding with an inability to pass urine. Examination revealed severe laceration of the anterior vaginal wall with complete urethral avulsion (Figure 1). Abdominal ultrasound findings showed that the urinary bladder was full and tender, with no intra-abdominal collection. The fetus was alive in the 26th week, with a cephalic presentation. Full informed consent was obtained for the possibility of preterm termination of pregnancy, urinary diversion, urethral stricture or fistula, incontinence, vaginal infection, or stenosis. Emergency surgery under general anesthesia, in the dorsal lithotomy position with hemostasis was carried out. A small catheter was passed from the anteriorly displaced meatus for 2 cm in the intact distal urethra, to the level of the avulsed urethra. Thereafter, the catheter was manipulated back into the bladder, until urine passed through the catheter from the urinary bladder. Primary urethral repair was performed trans-vaginally with end-to-end urethral anastomosis over stenting silicone catheter by interrupting 5/0 vicryl. The muscularis over the urethra was closed in a second layer, and the vaginal mucosa was then closed as a third layer by 2/0 vicryl; with an attempt being made to offset the suture line from the muscular closure (Figures 2a & 2b). The catheter was removed 4 weeks postoperatively, and the repair was intact. She was fully continent and voided satisfactorily with a good stream. At full term, a lower cesarean section was carried out and yielded a well baby of 3 kg. She was followed up every 2 months for 2 years to monitor any lower urinary tract symptoms and sexual dysfunction. Two years post surgery, she is continent with a good stream of urine with a normal sexual life (Figure 3).


Traumatic female urethral avulsion.

Al-Asbahi WA - Saudi Med J (2015)

Severe laceration of the anterior vaginal wall with complete urethral avulsion; with the catheter passed through the avulsed distal segment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4381025&req=5

Figure 1: Severe laceration of the anterior vaginal wall with complete urethral avulsion; with the catheter passed through the avulsed distal segment.
Mentions: A 35-year-old woman in the sixth month of pregnancy, presented to the emergency department post fall down straddle injury onto a sharp object (rock), during her work as a farmer. Her injuries involved the genitalia. There was profuse vaginal bleeding with an inability to pass urine. Examination revealed severe laceration of the anterior vaginal wall with complete urethral avulsion (Figure 1). Abdominal ultrasound findings showed that the urinary bladder was full and tender, with no intra-abdominal collection. The fetus was alive in the 26th week, with a cephalic presentation. Full informed consent was obtained for the possibility of preterm termination of pregnancy, urinary diversion, urethral stricture or fistula, incontinence, vaginal infection, or stenosis. Emergency surgery under general anesthesia, in the dorsal lithotomy position with hemostasis was carried out. A small catheter was passed from the anteriorly displaced meatus for 2 cm in the intact distal urethra, to the level of the avulsed urethra. Thereafter, the catheter was manipulated back into the bladder, until urine passed through the catheter from the urinary bladder. Primary urethral repair was performed trans-vaginally with end-to-end urethral anastomosis over stenting silicone catheter by interrupting 5/0 vicryl. The muscularis over the urethra was closed in a second layer, and the vaginal mucosa was then closed as a third layer by 2/0 vicryl; with an attempt being made to offset the suture line from the muscular closure (Figures 2a & 2b). The catheter was removed 4 weeks postoperatively, and the repair was intact. She was fully continent and voided satisfactorily with a good stream. At full term, a lower cesarean section was carried out and yielded a well baby of 3 kg. She was followed up every 2 months for 2 years to monitor any lower urinary tract symptoms and sexual dysfunction. Two years post surgery, she is continent with a good stream of urine with a normal sexual life (Figure 3).

Bottom Line: Traumatic female urethral avulsion in the absence of a pelvic fracture is an exceedingly rare entity, with no consensus on its' management.Here, we present a 35-year-old pregnant woman with severe anterior vaginal wall laceration and complete urethral avulsion secondary to straddle injury.Management consisted of primary urethral and vaginal repair.

View Article: PubMed Central - PubMed

Affiliation: Urology and Nephrology Center, Al-Thawra Modern General and Teaching Hospital, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. Tel. +967 (734) 929979. E-mail. walasbahi@hotmail.com.

ABSTRACT
Traumatic female urethral avulsion in the absence of a pelvic fracture is an exceedingly rare entity, with no consensus on its' management. Here, we present a 35-year-old pregnant woman with severe anterior vaginal wall laceration and complete urethral avulsion secondary to straddle injury. Management consisted of primary urethral and vaginal repair.

Show MeSH
Related in: MedlinePlus