Urethral Injury: Options and Solutions for Recovery

Urethral rupture in males?

My boyfriend had an unfortunate accident at work and fell from a high building, landing on his buttocks.
After being examined by a physician, he was diagnosed with: 1.
Pubic symphysis diastasis: The doctor mentioned that the normal width is about 0.5 cm, while my boyfriend's is approximately 1 cm, which is still within the acceptable range for natural healing.
2.
Urethral rupture: This is the part that concerns me the most.
After undergoing a urethrogram at Chang Gung Memorial Hospital, a laparoscopic surgery was scheduled to see if they could reconnect the urethra and create an artificial urethra.
Unfortunately, the surgery was unsuccessful.
The doctor explained that the rupture occurred right at the bone, meaning that when the pubic symphysis was fractured, the urethra was also torn, making it impossible to reconnect.
A major surgery is necessary, which may involve cutting a portion of the pubic bone.
While this is feasible, we consulted an orthopedic surgeon who advised against cutting due to potential complications.
I asked the doctor if the bone could be reattached after being cut, and he said no.
I truly don't know what to do.
The doctors mentioned that the urethral rupture is about 5-6 cm long, so I wonder if there are really no other options.
Isn't technology advanced nowadays? My boyfriend is only 30 years old and unmarried, and he is the only male in the family.
Just thinking about this makes me want to cry.
1.
Is there an artificial urethra available that is about 5-6 cm long? 2.
Is it possible to perform urethral reconstruction without cutting the pubic bone? 3.
If the pubic bone is cut, can it still be reattached, for example, using plates or other methods? Please, I am begging for help.

Shuhui, 20~29 year old female. Ask Date: 2007/05/07

Dr. Lin Hexing reply Urology

Dear Ms.
Shuhui,
Thank you for your inquiry.
I apologize for the delay in responding due to an oversight by our administrative staff.
I would like to address your question immediately.
This issue is quite complex and challenging, and it would be best for you to consult with a physician at a medical center that specializes in such surgeries for a clearer understanding.
A thorough evaluation should be conducted to provide you with the most accurate answers.
Currently, there are no synthetic artificial urethras available.
If needed, tissue can be harvested from the foreskin, bladder mucosa, or oral mucosa to accomplish this task.
It should be possible to perform the reconstruction without cutting the pubic bone, utilizing the upper bladder and lower perineum for the reconstructive surgery.
Lastly, I encourage you to visit other medical centers for further evaluation.
In the northern region, I recommend the Urology Department at Taipei Veterans General Hospital.
In the central region, you may consider the Urology Departments at Central Taiwan Veterans General Hospital or China Medical University Hospital for further diagnosis and consultation on appropriate treatment options.

Reply Date: 2007/05/07

More Info

Urethral injuries, particularly those resulting from trauma such as falls, can be complex and challenging to manage. Your boyfriend's situation, involving both a pubic symphysis diastasis and a urethral injury, requires careful consideration and a multidisciplinary approach to treatment. Let’s address your concerns systematically.

1. Artificial Urethra Options
In cases of significant urethral injury, particularly when there is a substantial gap (like the 5-6 cm you mentioned), reconstructive surgery is often necessary. While there are options for artificial urethras, they are typically used in specific cases where reconstruction is not feasible. The use of artificial urethras is still a developing field, and the success of such procedures can vary based on individual circumstances. It’s essential to consult with a urologist who specializes in reconstructive surgery to explore the latest advancements and options available.

2. Urethral Reconstruction Without Cutting the Pubic Bone
Urethral reconstruction can sometimes be performed without cutting the pubic bone, depending on the injury's specifics and the surgeon's expertise. Techniques such as using grafts from other tissues (like buccal mucosa) can be employed to bridge the gap in the urethra. However, the feasibility of this approach depends on the exact location and extent of the injury. A urologist with experience in complex urethral repairs would be the best person to evaluate this option.

3. Reattaching the Pubic Bone
If the decision is made to cut the pubic bone for access to repair the urethra, it is crucial to understand that this can lead to complications. While it may be technically possible to reattach the bone using plates or screws, the long-term outcomes can vary. There is a risk of nonunion (the bone not healing properly) and potential complications such as chronic pain or instability in the pelvic region. The decision to proceed with such a surgery should be made with careful consideration of the risks and benefits, ideally in consultation with both a urologist and an orthopedic surgeon.

Additional Considerations
- Multidisciplinary Approach: Given the complexity of your boyfriend's injuries, a team approach involving urologists, orthopedic surgeons, and rehabilitation specialists is crucial. This ensures that all aspects of his recovery are addressed, from surgical intervention to physical therapy.

- Rehabilitation: Post-surgery rehabilitation will be essential in restoring function and minimizing complications. This may include pelvic floor therapy, which can help strengthen the muscles around the urethra and improve urinary function.

- Psychological Support: The emotional toll of such injuries can be significant. It may be beneficial for your boyfriend to seek psychological support or counseling to help cope with the trauma and the impact on his life.

- Long-term Monitoring: Regular follow-ups with healthcare providers will be necessary to monitor healing and address any complications that may arise.

In conclusion, while the situation is undoubtedly challenging, there are options available. It is vital to engage with specialists who can provide tailored advice based on the latest medical advancements and your boyfriend's specific circumstances. Open communication with the medical team will be key in navigating this difficult journey.

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