Studi Kasus: Pengalaman Klinis dalam Mengatasi Ruptur Uretra

The intricate network of the human urinary system is susceptible to various injuries, with ruptures of the urethra being a particularly challenging clinical scenario. This delicate tube, responsible for transporting urine from the bladder to the outside, can be torn due to blunt trauma, penetrating injuries, or even iatrogenic causes. Managing these ruptures requires a comprehensive understanding of the anatomy, the extent of the injury, and the appropriate surgical techniques. This case study delves into a real-life clinical experience, highlighting the complexities of diagnosing and treating a urethral rupture, emphasizing the importance of meticulous surgical intervention and post-operative care.

The Case Presentation

The patient, a 35-year-old male, presented to the emergency room with severe pain in the perineum and inability to urinate. His history revealed a fall from a height, landing directly on his perineum. Upon examination, a large hematoma was evident in the perineal region, and a urethral catheter could not be passed. A retrograde urethrogram was performed, revealing a complete disruption of the membranous urethra, with extravasation of contrast media into the surrounding tissues. This confirmed the diagnosis of a urethral rupture.

Surgical Intervention and Repair

The patient was immediately taken to the operating room for surgical repair. The surgical approach involved a meticulous dissection of the perineum to expose the ruptured urethra. The torn ends of the urethra were carefully mobilized, and the defect was repaired using a primary end-to-end anastomosis. A Foley catheter was placed in the bladder to ensure adequate drainage and prevent tension on the repair. The surgical procedure was successful, with no evidence of bleeding or leakage.

Post-Operative Management and Recovery

Post-operatively, the patient was closely monitored for signs of infection, bleeding, and urinary leakage. The Foley catheter was maintained for two weeks to allow the urethral repair to heal. Antibiotics were administered to prevent infection. The patient was also advised to avoid strenuous activities and maintain a high fluid intake to promote healing.

The Importance of Early Diagnosis and Intervention

This case study underscores the critical importance of early diagnosis and prompt surgical intervention in managing urethral ruptures. Delay in treatment can lead to complications such as urinary fistulas, strictures, and chronic pelvic pain. The use of imaging techniques like retrograde urethrography is crucial for accurate diagnosis and assessment of the extent of the injury.

Conclusion

The successful management of this urethral rupture case highlights the importance of a multidisciplinary approach involving urologists, radiologists, and nurses. The meticulous surgical repair, coupled with appropriate post-operative care, ensured a favorable outcome for the patient. This case study serves as a valuable reminder of the complexities of managing urethral ruptures and the need for a comprehensive understanding of the anatomy, surgical techniques, and post-operative management.