Closed injuries and injuries of the prostate and seminal vesicles

The prostate and seminal vesicles are located in the depth of the small pelvis, protected by its bones and muscular aponeurotic crotch formations; anatomically and topographically closely related to the bladder, urethra, rectum, urogenital diaphragm, so their lesions are often multiple and combined.

Isolate closed injuries and injuries of the prostate and seminal vesicles and open trauma of the prostate and seminal vesicles. Prostate (prostata) - unpaired organ of the male reproductive system, located in the anterior part of the small pelvis under the bladder. Seminal vesicles (glandula seminalis) are paired formations related to internal male genital organs and protruding part of the vas deferens.

[1], [2], [3], [4]

Causes of the closed injuries of the prostate and seminal vesicles

Closed injuries and injuries 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 when forced insertion of metal instruments into the posterior part of the urethra, especially when it is narrowing or prostate adenoma.

[5], [6]

Symptoms of the closed injuries of the prostate and seminal vesicles

Endouretral injuries of the prostate can be single and multiple and are called false moves. Distinguish incomplete, i.e. Not penetrating the entire prostate, and full false passages, penetrating beyond it into the pelvic cellulose, seminal vesicles, bladder, rectum. Symptoms of closed injuries of the prostate and seminal vesicles - pain in the perineum  and anus, painful urination, hematuria, hemospermia.

In severe trauma, combined with significant damage to the pelvic bones, the clearly expressed symptoms of the latter smooth or hide the clinical signs of damage to the prostate and seminal vesicles. Damage of seminal vesicles in all cases is recognized late, since they do not have pathognomonic symptoms.

Endouretral injuries of the prostate are manifested by pain in the perineal region, bleeding from the urethra, painful difficulty urinating, acute urination retention.

Combined damage to the prostate and the urethra or bladder, full false moves can lead to urinary leakage, urinary infiltration and the appearance of phlegmon pelvic fat. In some cases, the development of urosepsis is possible.

[7], [8], [9], [10], [11]

Forms

Depending on the type of injury among the closed injuries, bruises and ruptures are isolated, with open injuries - bruises, tangents, blind and through wounds.

[12], [13], [14], [15]

Diagnostics of the closed injuries of the prostate and seminal vesicles

The diagnosis is established based on anamnesis, evaluation of the available symptoms of the results of a physical examination.

[16], [17], [18]

Clinical diagnosis

When rectal examination the prostate is enlarged, uneven consistency; in it can be determined areas of softening, determined infiltration of paraprostatic tissues, due to hemorrhage or urohematoma. Her palpation is very painful.

[19], [20], [21], [22], [23], [24], [25]

Instrumental diagnostics

Ultrasound and CT are of great help in diagnosing damage to this site . On the urethrocystograms, there can be visible streaks of contrast material in the prostate, paraprostatic fiber.

Treatment of the closed injuries of the prostate and seminal vesicles

With bruises of the prostate, patients are assigned bed rest, painkillers, hemostatic and antibacterial drugs. With a delay in urination, it is advisable to establish a permanent balloon catheter, sometimes using capillary puncture of the bladder; there may be indications for the application of the suprapubic urinary fistula.

To stop bleeding from the prostate, in addition to the usual haemostatic agents, successfully use a pressure bandage on the perineum, local hypothermia, tamponade of the bleeding prostate and the prostatic part of the urethra by dosing the catheter balloon with a fixed aseptic napkin on the urethral catheter at the external opening of the urethra.

Operative treatment

With tears of the prostate, its injury with pelvic bone fragments with extensive hemorrhages, there is sometimes a need for surgical treatment. It consists in exposing the prostate to the perineal or perioral or vesicular access, removing bone fragments from it, bleeding blood and blood clots, stopping bleeding by applying eight-suture seams or tamponade to the damaged and bleeding part of the prostate.