Skip to main content
SpringerLink
Log in

Harnröhrentraumen

Urethral trauma

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Harnröhrenläsionen können im Rahmen eines Traumas wie z. B. nach Verkehrsunfällen oder iatrogen nach endourologischen oder offenen chirurgischen Eingriffen (z. B. Prostatektomie, Inkontinenz-Operationen) auftreten. Selbst nach unglücklich erfolgten Katheterisierungsmanövern werden urethrale Läsionen angegeben. Das Verletzungsmuster betrifft entweder die anteriore oder die posteriore Harnröhre, selten ist die gesamte Urethra involviert. Detaillierte Anatomiekenntnisse sowie umfassende Erfahrung sind wesentliche Voraussetzungen für einen erfolgversprechenden rekonstruktiven Eingriff. Die Wahl der operativen Technik und des Op-Zeitpunkts hängen von der Traumagenese der Harnröhrenläsion ab. Aufgrund der möglichen Komplikationen wird eine primäre rekonstruktive Versorgung — insbesondere des hinteren Harnröhrenabschnittes — nur in ausgewählten Fällen empfohlen. Ein hier präsentierter therapeutischer Algorithmus soll chirurgisch-interventionelle Komplikationen wie Inkontinenz, Impotenz, rezidivierende Harnwegsinfektionen usw. vermeiden. Letztere beeinträchtigen die Lebensqualität der Patienten beträchtlich, insofern sie nicht selten multiple sekundäre Operationen nach sich ziehen. Somit ist eine sorgfältige primäre Diagnostik unter Zuhilfenahme verschiedener bildgebender Verfahren erforderlich.

Abstract

Urethral lesions may be caused by blunt or penetrating objects in the course of accidents, or can be iatrogenic resulting from invasive measures such as catheterization or other major surgical measures (prostatectomy or sling operations for continence). They can also be caused by foreign bodies deliberately introduced into the urethra. Injuries may primarily affect the anterior or posterior urethra. Urethral reconstruction presupposes knowledge of the precise anatomy of the pelvic region. The surgical techniques used and the timing of reconstructive procedures will depend on the cause and nature of the urethral injury. A definitive surgical intervention in most cases of lesions resulting from accidents is not generally recommended, especially when the lesion is in the posterior urethra. A treatment algorithm should prevent post-surgical complications such as incontinence, impotence, recurring urinary tract infections, etc., necessitating multiple operations, and assure an adequate quality of life. Diagnostic clarification of the exact nature of urethral injuries requires high quality imaging studies by specialists in the field.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11
Abb. 12
Abb. 13

Literatur

  1. Webster GD, Mathes GL, Selli C (1983) Prostatomembranous urethral injuries: a review of the literature and a rational approach to their management. J Urol 130: 898–902

    PubMed  Google Scholar 

  2. Herr HW (2004) Urological injuries in the Civil War. J Urol 172: 1800–1804

    Article  PubMed  Google Scholar 

  3. Elliott DS, Barrett DM (1997) Long-term followup and evaluation of primary realignment of posterior urethral disruptions. J Urol 157: 814–816

    Article  PubMed  Google Scholar 

  4. Koraitim MM (1996) Pelvic fracture urethral injuries: evaluation of various methods of management. J Urol 156: 1288–1291

    Article  PubMed  Google Scholar 

  5. Carlin BI, Resnick MI (1995) Indications and techniques for urologic evaluation of the trauma patient with suspected urologic injury. Semin Urol 13: 9–24

    PubMed  Google Scholar 

  6. Kricun ME (1990) Fractures of the pelvis. Orthop Clin North Am 21: 573–590

    PubMed  Google Scholar 

  7. Bredael JJ, Kramer SA, Cleeve LK, Webster GD (1979) Traumatic rupture of the female urethra. J Urol 122: 560–561

    PubMed  Google Scholar 

  8. Koraitim MM, Marzouk ME, Atta MA, Orabi SS (1996) Risk factors and mechanism of urethral injury in pelvic fractures. Br J Urol 77: 876–880

    PubMed  Google Scholar 

  9. Koraitim MM (1997) Posttraumatic posterior urethral strictures in children: a 20-year experience. J Urol 157: 641–645

    Article  PubMed  Google Scholar 

  10. Conolly W (1969) Observations on fractures of the pelvis. J Trauma 9: 104–111

    PubMed  Google Scholar 

  11. Pokorny M, Pontes JE, Pierce JM (1979) Urological injuries associated with pelvic trauma. J Urol 121: 455–457

    PubMed  Google Scholar 

  12. Palmer JK, Benson GS, Corriere JN Jr (1983) Diagnosis and initial management of urological injuries associated with 200 consecutive pelvic fractures. J Urol 130: 712–714

    PubMed  Google Scholar 

  13. Sevitt S (1968) Fatal road accidents. Injuries, complications, and causes of death in 250 subjects. Br J Surg 55: 481–505

    PubMed  Google Scholar 

  14. Levine JI, Crampton RS (1963) Major abdominal injuries associated with pelvic fractures. Surg Gynecol Obstet 116: 223–226

    PubMed  Google Scholar 

  15. Wilkinson FOW (1961) Rupture of the posterior urethra. Lancet 1: 1125

    Article  PubMed  Google Scholar 

  16. Williams DI (1975) Rupture of the female urethra in childhood. Eur Urol 1: 129–130

    PubMed  Google Scholar 

  17. Williams DI (1977) Rupture of the female urethra in childhood: nine cases. Birth Defects Orig Artic Ser 13: 239–240

    PubMed  Google Scholar 

  18. Perry MO, Husmann DA (1992) Urethral injuries in female subjects following pelvic fractures. J Urol 147: 139–143

    PubMed  Google Scholar 

  19. Venn SN GT, Mundy AR (1999) Pelvic fracture injuries of the female urethra. BJU Int 83: 626–630

    Article  PubMed  Google Scholar 

  20. Vicente J, Rosales A, Montlleo M, Caffaratti J (1992) Value of electrical dispersion as a cause of urethral stenosis after endoscopic surgery. Eur Urol 21: 280–283

    PubMed  Google Scholar 

  21. Hammarsten J, Lindqvist K, Sunzel H (1989) Urethral strictures following transurethral resection of the prostate. The role of the catheter. Br J Urol 63: 397–400

    PubMed  Google Scholar 

  22. Surya BV, Provet J, Johanson KE, Brown J (1990) Anastomotic strictures following radical prostatectomy: risk factors and management. J Urol 143: 755–758

    PubMed  Google Scholar 

  23. Besarani D, Amoroso P, Kirby R (2004) Bladder neck contracture after radical retropubic prostatectomy. BJU Int 94: 1245–1247

    Article  PubMed  Google Scholar 

  24. Eke N (2002) Fracture of the penis. Br J Surg 89: 555–565

    Article  PubMed  Google Scholar 

  25. Zargooshi J (2000) Penile fracture in Kermanshah, Iran: report of 172 cases. J Urol 164: 364–366

    Article  PubMed  Google Scholar 

  26. Aliabadi H, Cass AS, Gleich P, Johnson CF (1985) Self-inflicted foreign-bodies involving lower urinary-tract and male genitals. Urology 26: 12–16

    Article  Google Scholar 

  27. Osca JM, Broseta E, Server G, Ruiz JL, Gallego J, Jimenezcruz JF (1991) Unusual foreign-bodies in the urethra and bladder. Br J Urol 68: 510–512

    PubMed  Google Scholar 

  28. Rahman NU, Elliott SP, McAninch JW (2004) Self-inflicted male urethral foreign body insertion: endoscopic management and complications. BJU Int 94: 1051–1053

    Article  PubMed  Google Scholar 

  29. Chapple C, Barbagli G, Jordan G et al. (2004) Consensus statement on urethral trauma. BJU Int 93: 1195–1202

    Article  PubMed  Google Scholar 

  30. Lim PH, Chng HC (1989) Initial management of acute urethral injuries. Br J Urol 64: 165–168

    PubMed  Google Scholar 

  31. McAninch JW (1981) Traumatic injuries to the urethra. J Trauma 21: 291–297

    PubMed  Google Scholar 

  32. Sandler CM, Goldman SM, Kawashima A (1998) Lower urinary tract trauma. World J Urol 16: 69–75

    Article  PubMed  Google Scholar 

  33. Goldman SM, Sandler CM (1998) Upper urinary tract trauma — current concepts. World J Urol 16: 62–68

    Article  PubMed  Google Scholar 

  34. Morey AF, McAninch JW (1997) Role of preoperative sonourethrography in bulbar urethral reconstruction. J Urol 158: 1376–1379

    Article  PubMed  Google Scholar 

  35. Pontes JE, Pierce JM Jr (1978) Anterior urethral injuries: four years of experience at the Detroit General Hospital. J Urol 120: 563–564

    PubMed  Google Scholar 

  36. Steenkamp JW, Heyns CF, de Kock ML (1997) Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol 157: 98–101

    Article  PubMed  Google Scholar 

  37. Turner-Warwick R (1979) A urodynamic review of bladder outlet obstruction in the male and its clinical implications. Urol Clin North Am 6: 171–192

    PubMed  Google Scholar 

  38. Mundy A (1989) The treatment of sphincter strictures. Br J Urol 64: 626–628

    PubMed  Google Scholar 

  39. Mundy AR (1996) Urethroplasty for posterior urethral strictures. Br J Urol 78: 243–247

    PubMed  Google Scholar 

  40. Morey A, McAninch (1997) Reconstruction of posterior urethral disruption injuries: outcome analysis in 82 patients. J Urol 157: 506–551

    Article  PubMed  Google Scholar 

  41. Podesta ML, Jordan GH (2001) Pelvic fracture urethral injuries in girls. J Urol 165: 1660–1665

    Article  PubMed  Google Scholar 

  42. Orkin LA (1991) Trauma to the bladder, ureter and kidney. In: Sciarra JJ (ed) Gynecology and Obstetrics, vol 1 chapt 88. Lippincott, Philadelphia, pp 1–8

  43. Reynolds CJ (1942) The diagnosis and a new treatment of traumatic rupture of the posterior urethra. South Med J 35: 825–828

    Google Scholar 

  44. Thomas CL, McAninch JW (1989) Bladder trauma. AUA Update Series 8(31): 242–247

    Google Scholar 

  45. Wilbert D (1977) Untersuchung zum Pathomechanismus der Harnröhrenverletzungen bei Beckenfrakturen. Dissertation, Mainz

Download references

Danksagung:

Für die eindrucksvollen radiologischen Abbildungen und 3D-Rekonstruktionen gilt anerkennender Dank an OA Dr. Rieger, Radiologie 1, sowie Herrn Prof. Dr. Frauscher, Abteilung für Uro-Radiologie der Medizinischen Universitätsklinik Innsbruck.

Persönlicher Dank auch an Frau Prof. Dr. A. Mayr-Pernstich für ihre Unterstützung und sorgfältige Durchsicht des Manuskripts.

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Abteilung für Urologie, Medizinische Universitätsklinik Innsbruck, Österreich

    G.-M. Pinggera, P. Rehder, G. Bartsch & C. Gozzi

  2. Abteilung für Urologie, Medizinische Universitätsklinik Innsbruck, 6020, Innsbruck, Österreich

    G.-M. Pinggera

Authors
  1. G.-M. Pinggera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Rehder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Bartsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Gozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pinggera, GM., Rehder, P., Bartsch, G. et al. Harnröhrentraumen. Urologe 44, 883–897 (2005). https://doi.org/10.1007/s00120-005-0865-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-005-0865-x

Schlüsselwörter

Keywords

Search

Navigation