Tear in urethra

[felix234]

While installing an artificial urinary sphincter(aus) on my prostate- removed(due to radical prostatectomy in 2001) my urethra was torn-either by the surgeon or the aus. Urine was escaping thru the opening, went into the surrounding tissues, and exited the body thru the perineum suture throughout the day. I could still urinate normally thru the penis. Now I have a catheter(damn it!) to the bladder, removing urine from the tear site, hopefully, and allowing it to heal. Will it heal, in two weeks, as the Dr. said, by itself? Or do you think I will need further surgery, catheters, etc. to correct this mishap? The tear is just under the bladder, just above where the prostate might have been, just above the installed aus. I am an otherwise healthy male, 57 yrs, normal weight, ok BP, etc. --am a UPS delivery driver for 27 years. Why he had to screw-up the UPS driver at Xmas-I don't know--but that is another topic.   Thank you.

[Bhupinder Kaur, MD]

Hello,
Thanks for posting your query.

I can understand your concern for the tear in urethra which unfortunately occurred during the surgery for installation of artificial urinary sphincter.
Healing and treatment of urethral injury at the site that you have described( under the bladder and above the place where your prostate was before surgery is based around the grade of injury. The aim of treatment in urethral trauma is to maintain continence and potency and to reduce the occurrence of strictures; however diversion of urine is the first step undertaken.

Grade 1 injury is when stretch injuries are there that require no treatment., grade 2 causes contusion with blood at the urethral meatus and grade 3 includes partial disruption of anterior or posterior urethra. Grade 4 is complete disruption of anterior urethra and grade 4 is complete disruption of posterior urethra. Grade 5 is the most severe with complete or partial disruption of posterior urethra with associated tear of the bladder neck.

Grade 2 and grade 3 are managed conservatively with suprapubic cystostomy or urethral catheterisation which is being done in your case. Hence your injury may be grade 2 or 3 which hopefully can be managed conservatively.

In this urethral injuries can be treated with the insertion of a catheter, which is usually left in place for 14 to 21 days to allow the urethra to mend, and then an X-ray is performed to confirm that the injury has healed. Alternately a cystogram can also be done. If healing has taken place, the catheters are removed.

If the X-ray shows persistent leakage, the catheters are left for a while longer and then repeat X-rays or cystogram done. If the injury has healed, the catheter can be removed. Luckily approximately 75-85% of the time, the laceration is sealed and the injury is healed by this conservative approach.

Hence you should allow the catheter to be kept for 2-3 weeks and hopefully the injury should heal. However if there is any leakage after repeat x-rays/ cystograms, then surgical approach has to be taken.

Also you should keep in mind that blood in the urine can occur because of irritation from the catheters, but it usually disappears after they are removed. Scarring in the area of the urethral repair is the most common and most significant complication which may occur and cause one to strain during urination. This can usually be fixed by expanding the scarring with instruments placed up the urethra.

Hope that this information helps and hope that you will get better soon.

Wishing you good health.

[felix234]

Thank you. Your information, while accurate is disheartening. Not only are my customers and my work at UPS probably going to be disrupted during the Christmas season DUE TO THIS DR. ERROR, but, I just work up in a nightmare, that if this urethral injury is behind/under the aus, more time will be required to remove the aus, then re-install the catheter for more time to heal-causing me to be without income for the rest of the year, perhaps, during Christmas.  Wheras I did have the voiding test with the dye and x-ray--no one has told me what grade of urethral injury I have. I really feel like I've been "thrown under the bus" for the second time-the first with the radical prostatectomy that left me with all the problems associated with that treatment, and, now 12 years later, again with this botched operation.