- Email: [email protected]
Case profile: Unusual cause of acute urinary retention
CASE UNUSUAL CAUSE OF ACUTE __----. PROFILE: _-__ __.-URINARY RETENTION
A twenty-eight-year-old n was brought to the emergency room with a gunshot wound in his left buttock. He had been standing on a street corner ta&ing to a &end when he was shot from behind. Findings on physical examination were unremarkable, except for a bladder distended midway between symphysis and umbilicus and a 1 cm.-wide gunshot wound of the left buttock. The patient was unable to void, and there was some blocrpd oozing out of the urethra. The patient denied any previous illnesses. Attempts at catheter&&ion failed, and the patient was admitted to the urologic service. A plain film of the pelvis showed a bullet located at the region of the posterior urethra (Fig. 1). A retrograde urethrogram revealed the bullet completely blocking the posterior urethra with no contrast material going into the bladder. There was no evident extravasation (Fig. 2). In the operating room with the patient under anesthesia, the bullet could be palpated rectally distal to the prostatic apex. A sigmoidoscopy did not reveal any perforation of the sigmoid or rectum. A cvstotomy was performed. On inspection the bladder was found to be intact, and
FIGURE 2.
Retrograde
urethrogram
completely blocking posterior material going into bladder.
urethra;
lwllet no !*‘>f trast
reveuls
with the help of a urethral sound the bullr’ was gently manipulated upward and pushed int ) the bladder corn which it was then removed. Uter insertion of an 18 F Foley catheter via tht’ urethra the suprapubic wound was closed in 1 lyers around a 30 F Malecot tube. On the tenth postoperative day a voiding cystourethrogram showed the urethra to be ir tact. After removal of the suprapubic tube the w nrnd healed quickly. The patient was voiding well and with a good stream. He was discharged on the twelfth postoperative day. Alfred0 Iloreta, ?l. D. Schutte, M.D. (Rrp~-ints) Rafael Fernandez. 31. D. Jagdischandra Pat4 It 1. D. Mahammad Choudhury. ?:I. D. Barry Sonkin, ?4. D. Misericordia-Lincoln Medical Gjnter Department of Urr&)gy 234 East 149th St. Bronx, New York 10451 Heinrich
FIGURE 1. Plain film shows bullet located at region of posterior urethra.
UROLOGY
’
SEPTEMBER
1979
/
VOLUME
XIV,
NUMBER
3
20 I
A twenty-eight-year-old n was brought to the emergency room with a gunshot wound in his left buttock. He had been standing on a street corner ta&ing to a &end when he was shot from behind. Findings on physical examination were unremarkable, except for a bladder distended midway between symphysis and umbilicus and a 1 cm.-wide gunshot wound of the left buttock. The patient was unable to void, and there was some blocrpd oozing out of the urethra. The patient denied any previous illnesses. Attempts at catheter&&ion failed, and the patient was admitted to the urologic service. A plain film of the pelvis showed a bullet located at the region of the posterior urethra (Fig. 1). A retrograde urethrogram revealed the bullet completely blocking the posterior urethra with no contrast material going into the bladder. There was no evident extravasation (Fig. 2). In the operating room with the patient under anesthesia, the bullet could be palpated rectally distal to the prostatic apex. A sigmoidoscopy did not reveal any perforation of the sigmoid or rectum. A cvstotomy was performed. On inspection the bladder was found to be intact, and
FIGURE 2.
Retrograde
urethrogram
completely blocking posterior material going into bladder.
urethra;
lwllet no !*‘>f trast
reveuls
with the help of a urethral sound the bullr’ was gently manipulated upward and pushed int ) the bladder corn which it was then removed. Uter insertion of an 18 F Foley catheter via tht’ urethra the suprapubic wound was closed in 1 lyers around a 30 F Malecot tube. On the tenth postoperative day a voiding cystourethrogram showed the urethra to be ir tact. After removal of the suprapubic tube the w nrnd healed quickly. The patient was voiding well and with a good stream. He was discharged on the twelfth postoperative day. Alfred0 Iloreta, ?l. D. Schutte, M.D. (Rrp~-ints) Rafael Fernandez. 31. D. Jagdischandra Pat4 It 1. D. Mahammad Choudhury. ?:I. D. Barry Sonkin, ?4. D. Misericordia-Lincoln Medical Gjnter Department of Urr&)gy 234 East 149th St. Bronx, New York 10451 Heinrich
FIGURE 1. Plain film shows bullet located at region of posterior urethra.
UROLOGY
’
SEPTEMBER
1979
/
VOLUME
XIV,
NUMBER
3
20 I