Urethral trauma: Difference between revisions
No edit summary |
No edit summary |
||
| Line 10: | Line 10: | ||
*Hematuria, dysuria, inability to void, blood at meatus | *Hematuria, dysuria, inability to void, blood at meatus | ||
*Vaginal bleeding | *Vaginal bleeding | ||
*Perineal hematoma | *Perineal or scrotal hematoma | ||
*High-riding or detached prostate | *High-riding or detached prostate | ||
**Associated w/ complete posterior urethral disruption | **Associated w/ complete posterior urethral disruption | ||
==Management== | ==Management== | ||
===Imaging=== | ===Imaging=== | ||
Revision as of 01:49, 4 January 2015
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 or scrotal 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