Open injuries and injuries of the prostate and seminal vesicles

Open injuries and injuries of the prostate and seminal vesicles are observed in gunshot and stab wounds. Gunshot wounds (bullet, fragmentation, mine explosive) of these organs met quite often during the Great Patriotic War and, as a rule, were combined.

[1], [2]

Causes of the open trauma of the prostate and seminal vesicles

In modern military conflicts, mine-explosive wounds prevail, which are always combined. Gunshot wounds of the bladder and simultaneous damage to the prostate and pelvic bones account for 5.8% of the total number of gunshot combined bladder wounds and 16.7% of gunshot combined bladder and pelvic bones.

Iatrogenic lesions of the prostate and seminal vesicles during rectal and bladder removal operations, prostate biopsy, paraprostatic blockade, etc. Should also be mentioned.

[3], [4], [5], [6]

Symptoms of the open trauma of the prostate and seminal vesicles

The anatomical location of the prostate in the small pelvis predisposes to the combined injuries of the prostate, bladder and pelvic bones. In this regard, the clinical signs of a prostate injury are smoothed out or concealed by the symptoms of a bladder and pelvic injury. Only after some time, continuing  hematuria, dysuria and pain in the perineum and anus, radiating into the glans penis, make you suspect the injury of the prostate.

The main symptoms of stab-cut wounds of the prostate are bleeding, pain in the perineal and rectal areas, radiating to the glans penis, and urination disorders. With the combined damage of the urethra, bladder and rectum, urine inclusions, its release through the rectum or wound of the perineum, the passage of stool and gases through the wound can be attached.

The most characteristic sign of open damage to seminal vesicles is the flow of sperm from the wound or fistula formed.

Diagnostics of the open trauma of the prostate and seminal vesicles

Clinical diagnosis of open injuries of the prostate and seminal vesicles

The diagnosis of the wound of the prostate is determined taking into account the localization of the entrance and exit holes and the projection of the wound channel, examination of the perineum, finger examination, which makes it possible to determine the deformation of the organ. Often, the fact that a prostate is injured is confirmed during surgery for a bladder injury.

Diagnosis of stab wounds is based on assessment of complaints, history, wound localization, projection of the wound canal, results of physical examination with obligatory palpation of the prostate, data from the panoramic x-ray of the pelvic area, urethro- and fistulograms, ultrasound and CT of pelvic organs. MRI  allows you to diagnose not only damage to the prostate, but also surrounding tissues.

[7], [8], [9], [10], [11], [12], [13]

Treatment of the open trauma of the prostate and seminal vesicles

Operative treatment of open injuries of the prostate and seminal vesicles

The therapeutic tactics for combined bladder and prostate wounds are always operational and is determined, first of all, by the localization and necessity of an emergency stop of the continuing bleeding. In other cases, the sequence of the urologist's actions includes carrying out the lower-median laparotomy, primary treatment and suturing of the bladder wounds, sanation and drainage of the abdominal cavity with intraperitoneal bladder injury, sparing treatment of the prostate injury, hemostasis, imposition of the urinary fistula, drainage of the peri-bubble and paraprostatic tissue, laparotomy , treatment and drainage of musculoskeletal wounds and immobilization of bone fragments.

Treatment of injuries of the prostate consists in the primary surgical treatment of the wound, the removal of foreign bodies, stopping bleeding, opening and draining the urine stream and ulcers. With simultaneous damage to the urethra and rectum, superficial bladder fistula, an unnatural anus, drain the pelvic fat. If the seminal vesicle is damaged, it is usually limited to draining the wound.

Non-pharmacological treatment of open injuries of the prostate and seminal vesicles

Conservative treatment is possible for light isolated prostate wounds with minor bleeding and without signs of inflammation. An example is treatment after an uncomplicated prostate biopsy.

Forecast

Damage and trauma to the prostate and seminal vesicles have a favorable prognosis for life. With significant damage to these organs, the ability to perform sexual acts, fertilization may decrease, so during the treatment it is necessary to implement the saving principle of intervention and to conduct intensive therapy aimed at preventing and eliminating inflammatory complications.

[14], [15], [16], [17], [18]