Trauma and Reconstructive Surgery
The Trauma and Reconstructive Surgery Program at UCSF is directed
by Jack McAninch, MD, a world-renowned expert in urogenital trauma
and genital and urethral reconstruction. The program specializes
in treating patients who have voiding dysfunction symptoms, such
as a slow weak stream, frequency, nocturia, urgency, or urinary
retention, as a result of a urethral stricture or obstruction.
Most urethral strictures develop secondary to blunt trauma, eg
straddle injuries, while some urethral injuries are a result of
penetrating trauma, eg gun shot wounds or other obscure causes.
Patients seen at UCSF have a high success of voiding normally
after urethral reconstructive surgery.
Genital reconstruction is also done at UCSF for patients who
have suffered a traumatic genital injury or have genital skin
loss due to infection or other causes.
Other areas of specialty of the Trauma and Reconstructive Program
are management of traumatic injuries to the kidney, ureter, bladder,
scrotum/testicles, and penis.
McAninch has written over 250 articles on the management of urethral
abnormalities and urogenital trauma.
The male urethra is a conduit in continuity with the bladder, whose function is the passage of urine and semen. Anatomically it can be divided into posterior and anterior segments. Injuries to the posterior urethra are caused by blunt trauma, most commonly from motor vehicle accidents, falls or industrial crush injuries, and are associated with pelvic fractures. The mechanism of posterior urethral injury is a strong shearing force generated by the disruption of the pelvis, which pulls the prostatic urethra and its inferior pubic attachments in one direction while the membranous urethra is pulled in another. This results in rupture of the relatively unsupported membranous urethra, with displacement of the proximal urethral segment. Anterior urethral injuries are most frequently caused by blunt trauma. They usually occur after a straddle injury or a direct blow to the perineum. Other causes of anterior urethral stricture include idiopathic scarring, inflammation from infection or instrumentation and penetrating injuries.
Management of Urethral Injuries
Urethral Injuries can result in devastating long term consequences.
To a young person, the potential complications of impotence, stricture,
and incontinence often create life-long morbidity. Management
of these injuries can be complex and depends on the individual
case and the surgeon's expertise. As a general rule, initial suprapubic
cystotomy is the safest and simplest option; primary repair should
be limited to selected cases. Definitive management of urethral
injuries can be undertaken once the urethral healing process has
stabilized. At that time, the injury must be thoroughly reassessed
and an appropriate treatment plan developed. Flexibility at the
time of surgery is essential because intraoperative findings may
dictate diverging from the original plan. For this reason, a thorough
knowledge of the various reconstructive techniques is imperative.
A satisfactory functional and cosmetic result can be achieved
by adhering to these guidelines.
Ben Breyer, MD, MAS
Donna Deng, MD
Appointments & Location
Francisco General Hospital
1001 Potrero Avenue, 3A-20
San Francisco, CA 94110
Medical Center, Parnassus Campus
400 Parnassus Avenue, Suite A-610
San Francisco, CA 94143-0330
To schedule an appointment with McAninch or Breyer,
please call us at 415/476-3372
To schedule an appointment with Deng or
Tanagho, please call us at 415/353-2200