The evolution of the management of urethral injury
BAUS ePoster online library. Ivaz S. 11/10/20; 304263; P7-1
Ms. Stella Ivaz
Ms. Stella Ivaz
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The evolution of the management of urethral injury

Ivaz S1, Bugeja S1, Frost A1, Jeffery N1, Dragova M1, Mundy A1
1UCLH, London, United Kingdom

The first record of urethraltrauma followed an accident in 1087 when King William I and his army were raiding the town of Mantes. His horse was frightened, and William was thrown violently against the pommel of his saddle and sustained a straddle injury. His doctors knew this was fatal. They already appreciated that there was a difference between urethral rupture as a result of perineal trauma and when it was a result of a pelvic fracture. Catheterisability was a critical factor in diagnosis and treatment. A ruptured bulbar urethra was survivable if it could be catheterised and if the extravasation could be drained. A pelvic fracture related urethral injury (PFRUI) was almost invariably fatal. In 1757, Verguin had the idea of suprapubic catherisation from above and catheterisation below the injury (by perineal section) allowing railroading of a catheter across the site of the injury and into the bladder. The mortality of these injuries dropped because of the development of anaesthesia allowing Young and Campbell to try early primary-repair. Deansley (1907) and Hamilton Bailey (1927) recognised that the problem with PFRUI was posterior displacement of the bladder and prostate causing loss of alignment of the two ends of the urethra. All the subsequent developments of urethroplasty for PFUI came from Marion showing that the urethra had to be mobilised prior to repair. It was the work of Badenoch, Pierce, Payne and Coombes (transpubic approach) and of Waterhouse and Turner-Warwick who showed how extreme urethral mobilisation combined with various types of pubectomy could produce a tension free anastomosis.
The evolution of the management of urethral injury

Ivaz S1, Bugeja S1, Frost A1, Jeffery N1, Dragova M1, Mundy A1
1UCLH, London, United Kingdom

The first record of urethraltrauma followed an accident in 1087 when King William I and his army were raiding the town of Mantes. His horse was frightened, and William was thrown violently against the pommel of his saddle and sustained a straddle injury. His doctors knew this was fatal. They already appreciated that there was a difference between urethral rupture as a result of perineal trauma and when it was a result of a pelvic fracture. Catheterisability was a critical factor in diagnosis and treatment. A ruptured bulbar urethra was survivable if it could be catheterised and if the extravasation could be drained. A pelvic fracture related urethral injury (PFRUI) was almost invariably fatal. In 1757, Verguin had the idea of suprapubic catherisation from above and catheterisation below the injury (by perineal section) allowing railroading of a catheter across the site of the injury and into the bladder. The mortality of these injuries dropped because of the development of anaesthesia allowing Young and Campbell to try early primary-repair. Deansley (1907) and Hamilton Bailey (1927) recognised that the problem with PFRUI was posterior displacement of the bladder and prostate causing loss of alignment of the two ends of the urethra. All the subsequent developments of urethroplasty for PFUI came from Marion showing that the urethra had to be mobilised prior to repair. It was the work of Badenoch, Pierce, Payne and Coombes (transpubic approach) and of Waterhouse and Turner-Warwick who showed how extreme urethral mobilisation combined with various types of pubectomy could produce a tension free anastomosis.
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