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Endoscopy of the ruptured urethra

Endoscopy of the ruptured urethra

Journal D'urologie 90(6): 395-397

The diagnosis and management of rupture of the urethra were discussed at numerous meetings including no less than 4 of the Tri-annual Congresses of the International Society of Urology. Two questions were argued interminably: 1st, how to confirm the diagnosis and 2nd, when to intervene surgically. There are still a few surgeons who advocate the use of the diagnostic catheter despite its condemnation on grounds of fallibility and the risk of aggravating the extent of the urethral damage. At the 1976 Congress of the International Society of the Urology in Johannesberg there were 6 members on the panel and each 1 advocated a different time for surgical intervention, from immediate in the acute phase to 3 mo. after injury (Johansen, Macky, Marburger, Mitchell, Rocchi and Waterhouse, 1976). Of course, with any degree of delayed intervention some temporary urinary diversion by suprapubic cystostomy was necessary. Very little consideration, however, was given to the value of endoscopy, both as a diagnostic investigation and as 1 means of definitive surgery at a later stage. The development of the end-viewing (direct vision) urethroscope, giving a wide field of view throughout the whole length of the urethra, without the angulation required when using the old fore-oblique telescope, is making the viewing of the urethra a routine procedure as a preliminary to all cystoscopies. In Bristol in recent years endoscopy is attempted in all cases of urethral injury, in place of urethrography as a diagnostic procedure. Admittedly it is useless to carry out an endoscopy while blood is still pouring down the urethra, as no view will be possible. If the patient's condition permitted, endoscopy would be carried out without 24 to 48 h after the urethral bleeding had ceased. Three cases of anterior rupture were of particular interest.

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Accession: 005359778

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PMID: 6520410

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