Open injuries and trauma to the prostate and seminal vesicles

Open injuries and trauma to the prostate and seminal vesicles are observed with gunshot and stab wounds. Gunshot wounds (bullet, shrapnel, mine-explosive) of these organs were quite rare during the Great Patriotic War and, as a rule, were combined.

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Causes open injuries to the prostate and seminal vesicles

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

It is also worth mentioning iatrogenic damage to the prostate and seminal vesicles during operations to remove the rectum and bladder, prostate biopsy, paraprostatic blockade, etc.

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Symptoms open injuries to the prostate and seminal vesicles

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

The main symptoms of stab wounds of the prostate are bleeding, pain in the perineum and rectum, radiating to the head of the penis, and urination disorders. In case of combined injuries of the urethra, bladder and rectum, urine leakage, its release through the rectum or perineal wound, and the passage of feces and gases through the wound may be added.

The most characteristic sign of open damage to the seminal vesicles is the leakage of sperm from the wound or the resulting fistulas.

Diagnostics open injuries to the prostate and seminal vesicles

Clinical diagnostics of open injuries of the prostate and seminal vesicles

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

Diagnosis of stab wounds is based on the assessment of complaints, anamnesis, wound localization, projection of the wound channel, results of physical examination with mandatory palpation of the prostate, data from a general radiograph of the pelvic area, urethro- and fistulogram, ultrasound and CT of the pelvic organs. MRI allows diagnosing not only damage to the prostate, but also surrounding tissues.

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Treatment open injuries to the prostate and seminal vesicles

Surgical treatment of open injuries of the prostate and seminal vesicles

The treatment tactics for combined bladder and prostate wounds are always operative and are determined, first of all, by the localization and the need for emergency stopping of ongoing bleeding. In other cases, the sequence of actions of the urologist includes lower midline laparotomy, primary treatment and suturing of bladder wounds, sanitation and drainage of the abdominal cavity in case of intraperitoneal bladder wound, gentle treatment of the prostate wound, hemostasis, application of a vesical fistula, drainage of the perivesical and paraprostatic tissue, suturing of the laparotomy wound, treatment and drainage of bone and muscle wounds and immobilization of bone fragments.

Treatment of prostate injuries consists of primary surgical treatment of the wound, removal of foreign bodies, stopping bleeding, opening and drainage of urinary leaks and abscesses. In case of simultaneous damage to the urethra and rectum, a suprapubic bladder fistula, an artificial anus is applied, and the pelvic tissue is drained. In case of damage to the seminal vesicles, drainage of the wound is usually limited.

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

Conservative treatment is possible for mild isolated prostate injuries with minor bleeding and no signs of inflammation. An example would be 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 intercourse and fertilize may decrease, therefore, during treatment, it is necessary to implement the conservation principle of intervention and conduct intensive therapy aimed at preventing and eliminating inflammatory complications.

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