Skip to Main Content

++

CASE 5.1 RUPTURED URETHRA

++

Patient Presentation

A 12-year-old boy is admitted to the emergency department with complaints of a painful, enlarged scrotum and mild distention of the lower abdomen.

Relevant Clinical Findings History

The patient relates that 30 hours earlier, while racing with friends, his foot slipped from the pedal of his bicycle and he came down hard, straddling the bicycle frame. He has noticed the following, subsequent to the accident:

  • Weak urine stream

  • Mild penile pain during urination

  • Hematuria

Physical Examination

Results of physical examination of the external genitalia, anterior abdominal wall, and anal region:

  • Contusions to the scrotum

  • Subcutaneous fluid infiltration of the scrotum and shaft of the penis

  • Subcutaneous fluid infiltration of the inferior anterior abdominal wall

  • Normal anal canal and peri-anal region

Laboratory Tests
  • Urinalysis reveals erythrocytes and leucocytes.

Clinical Problems to Consider
  • Inguinal hernia

  • Rupture of spongy urethra with extravasation of urine

  • Sexual abuse

++

LEARNING OBJECTIVES

  1. Describe the fascial layers of the anterior abdominal wall and male urogenital (UG) region.

  2. Describe the subdivisions of the male urethra.

  3. Explain the contents of the superficial pouch of the male UG region.

  4. Explain the anatomical basis for the signs and symptoms associated with this case.

++

RELEVANT ANATOMY

++
Male Perineum
++

The male perineum is divided into two regions (Fig. 5.1.1):

++

  1. Anal triangle (posterior)

  2. Urogenital (UG) triangle (anterior)

++
Figure 5.1.1

Inferior view of the male perineum showing the urogenital and anal triangles. The superficial pouch is opened to reveal its contents.

Graphic Jump Location
++

The plane separating these regions passes through the perineal body at the midline and the anterior aspects of the ischial tuberosities laterally. The anus is the prominent feature for the anal triangle, while the external genitalia dominate the UG triangle. The body (shaft) of the penis and the scrotum are considered part of the UG triangle.

++
Fascia of the Male Urogenital Triangle
++
Superficial Fascia
++

Two distinct layers of the superficial (subcutaneous) fascia can be distinguished on the anterior abdominal wall, and are continuous into the UG triangle (Table 5.1.1). The terminology for these layers is different in each region.

++
Table Graphic Jump Location
Table 5.1.1Layers of superficial fascia.
++

There is a noteworthy difference between superficial layers on the anterior abdominal wall and the UG triangle:

++

  • On the anterior abdominal wall, the superficial layer (Camper) is composed primarily of fat.

  • On the scrotum, the superficial layer (dartos) contains numerous smooth muscle fascicles that insert on the dermis.

  • On ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.