Closed injuries and trauma to the prostate and seminal vesicles

The prostate and seminal vesicles are located deep in the pelvis, protected by its bones and muscular-aponeurotic formations of the perineum; anatomically and topographically, they are closely connected with the urinary bladder, urethra, rectum, urogenital diaphragm, therefore their injuries are most often multiple and combined.

There are closed injuries and traumas of the prostate and seminal vesicles and open injuries of the prostate and seminal vesicles. The prostate (prostata) is an unpaired organ of the male reproductive system, located in the anteroinferior part of the small pelvis under the urinary bladder. The seminal vesicles (glandula seminalis) are paired formations related to the internal male reproductive organs and protruding as part of the vas deferens.

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Causes closed injuries to the prostate and seminal vesicles

Closed injuries and trauma to the prostate and seminal vesicles can be damaged simultaneously with the membranous and prostatic parts of the urethra and rectum.

Iatrogenic damage to the prostate also occurs with the forced insertion of metal instruments into the posterior section of the urethra, especially with its narrowing or with prostate adenoma.

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Symptoms closed injuries to the prostate and seminal vesicles

Endourethral injuries of the prostate can be single or multiple and are called false passages. A distinction is made between incomplete, i.e. not penetrating the entire prostate, and complete false passages penetrating beyond its limits into the pelvic tissue, seminal vesicles, urinary bladder, and rectum. Symptoms of closed injuries of the prostate and seminal vesicles are pain in the perineum and anus, difficult painful urination, hematuria, and hemospermia.

In severe trauma combined with significant damage to the pelvic bones, the clearly expressed symptoms of the latter smooth out or hide the clinical signs of damage to the prostate and seminal vesicles. Damage to the seminal vesicles is always recognized late, since it does not have pathognomonic symptoms.

Endourethral injuries of the prostate are manifested by pain in the perineum, bleeding from the urethra, painful difficult urination, and acute urinary retention.

Combined damage to the prostate and urethra or bladder, complete false passages can lead to urinary leaks, urinary infiltration and the development of pelvic phlegmon. In some cases, urosepsis may develop.

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Forms

Depending on the type of injury, closed injuries include bruises and ruptures, while open injuries include bruises, tangential, blind and penetrating wounds.

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Diagnostics closed injuries to the prostate and seminal vesicles

The diagnosis is established on the basis of the anamnesis, assessment of existing symptoms and results of a physical examination.

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Clinical diagnostics

Rectal examination reveals that the prostate is enlarged and of uneven consistency; softening areas may be detected in it, and infiltration of paraprostatic tissues due to hemorrhage or urohematoma is detected. Its palpation is extremely painful.

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Instrumental diagnostics

Ultrasound and CT are of great help in diagnosing damage to this localization. Urethrocystograms may show leaks of contrast agent into the prostate and paraprostatic tissue.

Treatment closed injuries to the prostate and seminal vesicles

In case of prostate contusions, patients are prescribed bed rest, painkillers, hemostatic and antibacterial drugs. In case of urinary retention, it is advisable to install a permanent balloon catheter, sometimes capillary punctures of the bladder are used; indications for the imposition of a suprapubic bladder fistula may arise.

To stop bleeding from the prostate, in addition to conventional hemostatic agents, a pressure bandage on the perineum, local hypothermia, tamponade of the bleeding prostate and the prostatic part of the urethra with a dosed tension of the balloon catheter using a fixed aseptic napkin on the urethral catheter at the external opening of the urethra are successfully used.

Surgical treatment

In case of prostate ruptures, its injury by fragments of pelvic bones with extensive hemorrhages, sometimes there is a need for surgical treatment. It consists of exposing the prostate through perineal or retropubic or urinary bladder access, removing bone fragments, spilled blood and blood clots from it, stopping the bleeding by applying figure-of-eight sutures or tamponade of the damaged and bleeding part of the prostate.