會陰部撞擊後的尿道損傷處置

唐慈翊^1-3、吳怡萱^1,2

高雄市立小港醫院¹泌尿科;

高雄醫學大學附設醫院²泌尿科;

 高雄醫學大學醫學院³泌尿學科

Management of Urethral Rupture Following Blunt Perineal Trauma

Tsz-Yi Tang^1,2,3, Yi Xuan Wu^1,2

¹Department of Urology, Kaohsiung Municipal SiaoGang Hospital, Kaohsiung, Taiwan;

²Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;

³Department of Urology, Kaohsiung Medical University, Kaohsiung, Taiwan

Case report:

A 60-year-old male patient presented to the emergency department (ED) after sustaining a blunt perineal injury. The mechanism of injury involved the patient jumping off a cleaning vehicle and hitting a railing with his groin area. On presentation, the patient complained of hematuria and scrotal swelling. Vital signs were stable, and initial blood work returned normal results. Physical examination showed no obvious penis deformity or swollen scrotum (Figure 1). An abdominal computed tomography (CT) scan revealed a rupture of the corpus spongiosum (Figure 2). Upon diagnosis in the ED, an immediate cystostomy was performed smoothly to ensure urinary diversion and decrease the risk of further urethral injury. The following day, an attempt for early endoscopic realignment was made, utilizing a 6Fr ureteroscope (URS) for urethral access. However, due to extensive rupture and the presence of blood clots, navigation through the urethra was unsuccessful (Figure 3), and it was not possible to place a urethral catheter.

Given the patient's stable condition and the unsuccessful attempt at endoscopic realignment, the decision was made not to pursue further immediate surgical intervention. The patient was closely monitored for signs of infection, urinary retention, and other potential complications. Remarkably, the patient's condition remained stable, and he was discharged from the hospital the day after the attempted endoscopic realignment.

Conclusion:

Corpus spongiosum rupture due to blunt perineal trauma requires prompt and careful evaluation and management. Although early endoscopic realignment is a beneficial approach in some cases, it may not be successful in the presence of extensive rupture and obstruction. This case emphasizes the recommendation that, in managing urethral injuries, considering cystostomy, it may also be beneficial to simultaneously utilize upper and lower cystoscopes or ureteroscopes to locate the injury site, which could enhance the success rate. Additionally, waiting for two weeks for the absorption of blood clots before attempting endoscopic realignment might increase the likelihood of a successful outcome.