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Urethral trauma
From WikEM
Contents
Background
- Commonly result of blunt trauma
- Missed or inadequately managed injuries can result in strictures and recurrent urologic procedures
Types
- Anterior
- Located anterior to the membranous urethra
- Straddle injuries, self-instrumentation
- Posterior
- Located in the membranous and prostatic urethra
- Due to blunt trauma from massive deceleration[1]
- Often accompanies pelvic fracture
Clinical Features
- Hematuria, dysuria, inability to void, blood at meatus
- Vaginal bleeding
- Perineal or scrotal hematoma
- High-riding or detached prostate
- Associated with complete posterior urethral disruption
Differential Diagnosis
Genitourinary trauma
- Bladder trauma
- Urethral trauma
- Testicular trauma
- Penile trauma
- Vaginal trauma
- Sexual assault
- Child abuse
Evaluation
- Standard "trauma CT" is likely to miss urethral trauma[2]
- Retrograde urethrogram
- Must perform before catheterization to prevent further urethral injury
- 60 mL of water soluble contrast in toomey syringe
- Stretch penis perpendicularly across patient's thigh to unfold urethra.
- Inject 60 cc slowly into urethra (to prevent venous intravasation) while putting pressure on the glans to prevent leakage, shoot KUB during last 10 mL
- No bladder filling with extravasation - complete tear
- Bladder filling with extravasation - partial tear
Management
- Posterior urethral injury
- Suprapubic cathether placement
- Surgery is usually performed weeks later
- Anterior urethral injury
- Penetrating injuries require surgical exploration and repair
