Des Ruptures de l'Urètre chez l'Homme par Bicyclette

By Gustave-Adolphe Walther189815 chapters25 imagesFrench

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Contents

• AVANT-PROPOS (opens in a new tab)

  The author, Walther, an American student at the Paris Faculty of Medicine, thanks his professors and mentors, especially thesis president Tillaux and Drs Letulle, Schwartz, Ricard and Rieffel, several of whom supplied case observations used in the thesis.
• INTRODUCTION (opens in a new tab)

  Notes that no standard textbook yet lists cycling among the causes of traumatic urethral hemorrhage and rupture, and states the thesis, drawing on Terrillon's and Quénu/Picqué's work, will focus narrowly on the frequency, causes and clinical signs of urethral tears caused by bicycle saddles.
• CHAPITRE PREMIER. Étiologie. (opens in a new tab)

  Surveys how rarely urethral rupture from cycling occurs (mainly among experienced riders who manage to avoid falling outright rather than novices), the mechanism by which the handlebar, frame, rear wheel or especially the saddle nose crushes the urethra against the pubic arch in a straddle fall, and predisposing factors relating to the rider, the road surface, and the bicycle's saddle springs versus pneumatic tires.
• CHAPITRE II. Aperçu clinique et thérapeutique. (opens in a new tab)

  Following Cras and Guyon's three-tier classification of straddle-fall urethral injuries (mild, moderate, severe), surveys the clinical picture and treatment appropriate to each grade, from simple urethrorrhagia needing no treatment through catheterizable retention to severe cases requiring external urethrotomy, as illustrated by the case reports that follow.
• OBSERVATION II. Urétrorragie traumatique chez un bicycliste. (opens in a new tab)

  Dr Bouglé's case: a medical student, V.B..., twice finds his shirt stained with blood after vigorous rides without ever noticing pain or urinary difficulty, an example of a mild case resolving without treatment.
• OBSERVATION III. Rupture de l'urètre chez un vélocipédiste. (opens in a new tab)

  A 17-year-old cyclist, L..., feels a jolt over a paving stone, notices blood on his shirt only that night, and is diagnosed with a mild urethral rupture that heals with a few days' rest.
• OBSERVATION IV. Rupture traumatique du corps caverneux. (opens in a new tab)

  Dr Schwartz's Hôpital Cochin case: a 36-year-old gilder, Louis L..., falls astride his handlebars, developing a perineal hematoma and traumatic rupture of the corpus cavernosum that resolves with bed rest over several weeks, with no resulting stricture.
• OBSERVATION V. Rupture de l'urètre par bicyclette. Cathétérisme. Guérison. (opens in a new tab)

  Baumgarten's case: a 20-year-old man falls backward onto the saddle nose while dismounting, developing complete urinary retention treated by catheterization; a urethroscope later reveals a healed transverse scar in the bulbous urethra.
• OBSERVATION VI. Rupture de l'urètre chez un vélocipédiste. Cathétérisme. Guérison. (opens in a new tab)

  Dr Rieffel's case: a man thrown into the air by a sudden jolt crossing the Place de la République falls onto the saddle, requiring catheterization for retention, and later develops a traumatic stricture needing regular dilation up to a No. 40 Béniqué sound.
• OBSERVATION VII. Chute à califourchon sur la roue d'arrière d'une bicyclette. Rupture complète de l'urètre. Suture de l'urètre. Guérison. (opens in a new tab)

  Dr Ricard's case: a schoolteacher falls astride his bicycle's solid-rubber rear wheel, suffering a complete urethral rupture that Ricard repairs by perineal incision and end-to-end catgut suture, with a full, uncomplicated recovery.
• OBSERVATION VIII. Rupture de l'urètre chez un vélocipédiste. (opens in a new tab)

  A 25-year-old blacksmith falls into a roadside ditch onto the saddle nose, keeps riding 14km despite bloody urine, and is treated at the Hôtel-Dieu de Rennes by external urethrotomy after catheterization fails, healing over several weeks of graduated dilation.
• OBSERVATION IX. Chute à califourchon sur le vélocipède. Rupture de l'urètre. Rétrécissement traumatique. Abcès et fistule. Urétrotomie externe. (opens in a new tab)

  Professor Guyon's Necker hospital case: a 62-year-old man's straddle fall onto his rear wheel leads to urinary retention, a perineal abscess and fistula persisting for months, eventually resolved by external urethrotomy and resection of scar tissue.
• OBSERVATION X. Chute à califourchon sur la bicyclette. Rupture de l'urètre. Rétrécissement. Urétrotomie externe. Guérison. (opens in a new tab)

  Another Guyon case: a 34-year-old wire-drawer's saddle fall causes urethral rupture and a stricture so severe that a second operation is needed to locate and reconnect the posterior urethral stump before he heals.
• OBSERVATION XI. Rupture des ressorts de la selle, chute sur le portant métallique. Urétrorragie. Rétention d'urine. Urétrotomie externe. (opens in a new tab)

  De Pezzer's case: a 30-year-old man falls onto the bare metal saddle frame when its springs suddenly break, developing urethrorrhagia and urinary retention treated by external urethrotomy, with the wound later suppurating before healing.
• CONCLUSIONS (opens in a new tab)

  Concludes that urethral rupture from a straddle fall onto a bicycle part, especially the saddle nose, is an uncommon but genuine accident type sharing the same mechanism as other straddle-fall injuries, generally carrying a favorable prognosis when the case is recognized and treated appropriately.