B30. Injuries of the bladder, urethra, penis, and scrotum

Bladder injury

Etiology
- Pelvic fracture
- Iatrogenic
Diagnosis
- CT cystography
Types
- Intraperitoneal -> injury communicates with peritoneum
  - Damage of bladder dome, which is intraperitoneal
- Extraperitoneal -> injury is confined to extraperitoneal space
  - The rest of the bladder is extraperitoneal
Clinical features
- Gross haematuria
- Suprapubic pain
- Inability to urinate
- Intraperitoneal -> peritoneal irritation
Treatment
- Foley or suprapubic catheter
- Extraperitoneal bladder injury -> non-operative
- Penetrating injury -> surgery
- Intraperitoneal bladder injury -> surgery

Types
- Affecting the posterior urethra
  - Due to pelvic fracture
- Affecting the anterior urethra
  - Due to straddle injury
Clinical features
- Inability to void
- Blood at urethral opening
Diagnosis
- Retrograde urethrogram
Treatment
- Posterior urethra injury -> suprapubic catheter
- Anterior urethra injury -> surgery

Usually due to traumatic bending of erect penis during intercourse
- The tunica albuginea ruptures
- Often associated with anterior urethra injury
Clinical features
- Snapping sound as the tunica albuginea ruptures
- Immediate loss of erection
- Pain
- Swelling, curving, and haematoma
  - Gives it an “eggplant” appearance
Diagnosis: clinical
Treatment
- Surgical repair of tunica albuginea
- Surgical evacuation of haematoma

Laceration of skin -> surgical repair
Complete scrotal avulsion -> transplant the testis into subcutaneous thigh pouches -> transplant it back into the scrotum later with a skin graft

Blunt trauma
Clinical features
- Severe pain
  - Locally and abdominally
- Swelling
- Nausea/vomiting
- Haematocele
Diagnosis
- Ultrasound
- Surgical exploration
Treatment
- Small haematocele -> conservative treatment
- Large haematocele -> surgical drainage
- Testicular rupture -> immediate surgery