Urethral trauma

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
  • Often accompanies pelvic fx

Presentation

• Hematuria, dysuria, inability to void, blood at meatus
• Vaginal bleeding
• Perineal hematoma
• High-riding or detached prostate
  • Associated w/ complete posterior urethral disruption

Management

Imaging

• Retrograde urethrogram
  • Must perform before catheterization to prevent further urethral injury
  • 60 mL of water soluble contrast in toomey syringe
  • Stretch penis perpendicularly across pt'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

Treatment

• Posterior urethral injury
  • Suprapubic cathether placement
  • Surgery is usually performed weeks later
• Anterior urethral injury
  • Penetrating injuries require surgical exploration and repair

See Also

GU Trauma