Anatomoclinical, therapeutic and medico-legal aspects of post-traumatic ruptures of the urethra in Conakry

Abstract

Objective: To report the anatomoclinical aspects and management of post-traumatic urethral ruptures as well as the medico-legal evaluation of victims in Conakry.

Material and methods: This was a descriptive study with retrospective data collection over a ten-year period, conducted between January 1, 2013, and December 31, 2022, inclusively. It was carried out at two practice sites of the authors in Conakry. During this period, it collected all patients followed for post-traumatic urethral rupture with an exploitable medical file. The European Association of Urology classification was adopted for lesion typing. The parameters studied were: age, profession, reason for admission, circumstances of occurrence, mechanisms of occurrence, type of rupture, site of rupture, associated lesions, therapeutic attitude, treatment results, and medico-legal evaluation.

Results: Post-traumatic urethral ruptures represented 12.7% of all pelvi-perineal traumas recorded in surgical emergencies. The mean age was 29.7 ± 11.3 years with extremes of 5 and 68 years. Urethrorrhagia (74.5%) and acute urinary retention (62.3%) were the most common urological reasons for consultation. Functional impairment of the lower limbs was present in 80.2% of patients. The circumstances of trauma occurrence were dominated by traffic accidents (54.7%). In 41.5% of cases, urethral rupture occurred by shearing. It was complete in 79.2% of cases and predominantly affected the posterior urethra (75.5%). Pelvic fracture was the most common associated lesion (72.6%). Late urethral repair was the most observed therapeutic approach. It consisted of urethroplasty by resection anastomosis in 75.5% of patients previously diverted by cystostomy. Endoscopic internal urethrotomy concerned 14.1% of patients. Immediate surgical repair of the urethra was performed in only 9.4% of cases. The therapeutic outcomes were favourable in the majority of cases (82.1%). Erectile dysfunction, infertility, and urethral stenosis were the evolutionary sequelae associated. The evaluation of total temporary incapacity (TTI) revealed a mean disability duration of 88.2 days, with 75.5% of patients presenting TTI greater than 35 days. Permanent partial incapacity (PPI) concerned 21.7% of patients with a mean PPI of 5.75%, mainly due to sequelae associated with therapeutic outcomes.

Conclusion: Post-traumatic urethral ruptures require a multidisciplinary approach to optimise management and compensation of victims.