The initial management of complete urethral disruption in a deployed military field hospital

• Published in: Injury extra Vol. 43; no. 9; pp. 65 - 67
• Main Authors: Watchorn, James C, Standley, David M, Smith, Jason E, Burgess, Andrew J, Midwinter, Mark J, Lambert, Anthony W
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-09-2012
• Subjects: Orthopedics; Pelvis; Trauma; Urethra; Urethra; Pelvis; Trauma
• ISSN: 1572-3461; 1572-3461
• DOI: 10.1016/j.injury.2012.05.026

Abstract Background The management of male urethral trauma in the multiply injured battle casualty has proved challenging to the deployed military trauma surgeon. Foreign nationals will need culturally sensitive outcomes with adequate urinary function when further surgical management is unlikely to be available in a developing country. For those likely to undergo reconstructive surgery, the early restoration of anatomy is important as it may improve the long-term reconstructive outcome. Method We illustrate our technique with a case report and discuss salient points of other patients treated in the same manner, all of whom presented to a role 2 (enhanced) field hospital in Afghanistan with urethral injuries. Results A transpelvic high velocity gunshot wounds (HVGSW) was sustained and the patient underwent immediate anatomical re-alignment of the urethra with suture of the bladder neck to the pelvic floor. This case is discussed in detail. Conclusions Complete disruption of the male urethra can be successfully managed in the field hospital by urethral catheterization at the time of initial surgery. In patients where further reconstruction may not be possible, urethral catheterization provides a culturally permissible solution for patients. In those who may undergo further reconstructive surgery, approximation of the bladder to the pelvic floor may reduce stricture rate in comparison with the suprapubic catheterization alone.