Genitourinary complications of pelvic traumaLes complications uro-génitales des traumatismes du bassin: a propos de 41 cas

Objective: To analyse the epidemiological features, diagnostic criteria and therapeutic aspects of 41 genitourinary lesions due to pelvic fracture. Patients and Methods : This is a retrospective analysis of 41 consecutive cases of pelvic trauma associated with urinary or genital complications seen over a 5-year period at the University Hospital of Treichville, Abidjan, Côte d'Ivoire. The patients had a mean age of 27.8 years (range: 14 – 48 years) with a male-to-female ratio of 9.25 to 1. Results: Traffic accidents were the prevailing cause of trauma accounting for 75.6%. The commonest type of fracture was anterior arc fracture encountered in 26.9% of the patients. The commonest presenting symptoms were chronic urinary retention (16.7%), bleeding per urethram (10.4%) and hematuria (29.1%). Urethral lesions were encountered in 50%, bladder lesions in 38.5%, lesions of the external genitalia in 9.6% and prostatic lesions in 1.9% of patients. In the majority of the patients (51.2%) urethral repair was attempted by the spatulated anastomotic technique. In cases of disruption of the membranous urethra, urethral repair was delayed by 3 months. The functional results of treatment were good in 66%, while satisfactory erectile function could be achieved in 73% of the patients. Mortality was 4.9%. Conclusion: The prognosis of patients with pelvic trauma can be improved by a fast diagnosis and by resorting to a multidisciplinary team taking care of the multiple visceral injuries in association with the urogenital ones. Résumé Objectifs: Analyser les données épidémiologiques, diagnostiques et thérapeutiques des complications uro-génitales de 41 cas de traumatismes du bassin. Patients et méthode: Il s'agit d'une étude rétrospective effectuée à partir de 41 cas de traumatismes du bassin avec complication urinaire et/ou génitale colligés dans le service d'urologie du CHU de Treichville sur une période de cinq ans. L'âge moyen des patients est de 27,8 ans (extrêmes: 14 à 48 ans), avec un sexe ratio de 9,25 hommes pour une femme. Résultats: Les accidents de la voie publique sont les plus grands pourvoyeurs de traumatisme représentant 75,6% des cas. Les fractures de l'arc antérieur sont les plus incriminées (26,9%). Les signes cliniques les plus évocateurs sont: la rétention aiguë d'urines (16,7%), l'urétrorragie (10,4%) et l'hématurie (29,1%). Nous avons observé 50% de lésions urétrales, 38,5% de lésions vésicales, 9,6% d'atteintes des organes génitaux externes et 1,9% de lésions prostatiques. Nous avons opté pour une réparation à distance du traumatisme causal (3 mois) pour les ruptures de l'urètre membraneux en faisant une large part à la résection-anastomose avec spatulation (51,16%). Nous avons obtenu 66% de bons résultats sur le plan urinaire et 73% de conservation d'une fonction érectile satisfaisante tandis qu'une mortalité de 4,9% assombrit le pronostic.Conclusion: Le pronostic peut être amélioré par la célérité du diagnostic et la prise en charge des lésions qui sont squelettiques et souvent poly-viscérales chez les patients présentant des lésions uro-génitales consécutifs aux traumatismes du bassin, c‘est à dire la nécessité d'une prise en charge spécialisée pluridisciplinaire. African Journal of Urology Vol. 12(1) 2006: 37-4

The structure and innervation of the male urethra: histological and immunohistochemical studies with three-dimensional reconstruction

The structure of the striated urethral sphincter, the so-called rhabdosphincter, remains the subject of controversy. There are two main concepts regarding its structure: either it is a part of the urogenital diaphragm, or it extends from the base of the bladder up to the urogenital diaphragm and is an integral part of the urethra. It is also uncertain whether it possesses a somatic innervation or a mixed innervation (i.e. autonomic and somatic). The purpose of this study was to show the precise location of the nerves running to the urethra, and to try to determine their exact nature. Histology and immunohistochemistry were performed in the external urethral sphincter of ten male fetuses (114–342 mm crown–rump length, or between 14 and 40 weeks of gestation). A three-dimensional (3D) reconstruction of the urethral structure and its innervation was made from serial sections. The 3D reconstruction of the same section levels with different strains allowed us to identify the precise structure of the muscle layers (smooth and striated muscle fibres) and the nature of the nerve elements (myelinated and unmyelinated), their distributions and their relationship to the urethral wall, the prostate and the seminal vesicles. Histological and immunohistochemical 3D reconstruction of the anatomical elements of the urethral sphincter helps us to understand the 3D arrangement of the sphincter muscle layers. It also provides a better understanding of the origin and nature of the nerve elements that play a role in urinary continence