ISSN 2398-2969      

Urethra: rupture

icanis

Introduction

  • Cause: road traffic accident (RTA) with pelvic fracture or fracture of os penis, urethral obstruction, bites, ballistic injuries, iatrogenic injury through catheterization.
  • Signs: dysuria, hematuria, anuria, abdominal distension, perineal or preputial swelling.
  • Diagnosis: signs, contrast urethrography.
  • Treatment: correct metabolic anomalies prior to definitive treatment.
  • Many lacerations can be managed by urinary diversion.
  • More severe injuries require surgical intervention.
  • Prognosis: good if metabolic anomalies can be corrected prior to treatment.

Pathogenesis

Etiology

  • RTA with pelvic fracture or fracture of os penis (usually rupture at pelvic or penile site). Can also occur without fracture.
  • Urethral obstruction (usually perineal site) Urethra: obstruction.
  • Iatrogenic injury through catheterization (usually perineal site).
  • Bites.
  • Ballistic injuries.

Predisposing factors

General
  • Male dogs.
  • Urinary calculi may be associated with specific breeds; struvite calculi associated with infection; calcium oxalate calculi associated with hypercalcemia Hypercalcemia: overview.

Pathophysiology

  • Degree of urethral trauma may vary from minor laceration to complete severance.
  • Results in uroabdomen or periurethral cellulitis depending on site.
  • Urine leaks into periurethral tissue/abdomen causing cellulitis/peritonitis.
  • Often leucocytosis.
  • Dehydration, hypoproteinemia Hypoproteinemia , hypoglycemia Hypoglycemia.
  • Azotemia Azotemia in some cases.
  • Rupture of the urethra can occur intra-abdominally causing uroabdomen as with bladder rupture Bladder: trauma rupture.
  • If the urethral tear is extra-abdominal, urine leaks into the periurethral tissues causing cellulitis.
  • Azotemia results from reabsorption of urine by the tissues or peritoneum.
  • Tissue necrosis at the site of urethral rupture results in leukocytosis.
  • Azotemia/cellulitis/necrosis result in clinical signs of lethargy, vomiting, anorexia → dehydration.
  • Peritonitis causes fluid, protein loss, electrolyte abnormalities.

Timecourse

  • Hours to days.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Mahler S P & Wint C E (2004) What is your diagnosis? Urethral trauma. JAVMA 225 (6), 839-840 PubMed.
  • Cooley A J et al (1999) The effects of indwelling transurethral catheterization and tube cystomtomy on urethral anastomoses in dogs. JAAHA 35 (4), 341-7 PubMed.
  • Bjorling D E, Petersen S W (1990) Surgical techniques for urinary tract diversion and salvage in small animals. Comp Cont Ed Pract Vet 12 (12), 1699-704 VetMedResource.
  • Anson L W (1987) Urethral trauma and principles of urethral surgery. Comp Cont Ed Pract Vet (10), 981-88 VetMedResource.
  • Pechman R D Jr. (1982) Urinary trauma in dogs and cats - a review. JAAHA 18 (1), 33-40 IAEA INIS.
  • Selcer B A (1982) Urinary tract trauma associated with pelvic trauma. JAAHA 18 (5), 785-93 VetMedResource.

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