Urethral trauma: Difference between revisions
m (Rossdonaldson1 moved page Urethral Trauma to Urethral trauma) |
No edit summary |
||
| Line 1: | Line 1: | ||
==Types== | ==Background== | ||
===Types=== | |||
*Anterior | *Anterior | ||
**Located anterior to the membranous urethra | **Located anterior to the membranous urethra | ||
| Line 7: | Line 8: | ||
**Due to blunt trauma from massive deceleration | **Due to blunt trauma from massive deceleration | ||
**Often accompanies pelvic fx | **Often accompanies pelvic fx | ||
==Presentation== | |||
==Clinical Presentation== | |||
*Hematuria, dysuria, inability to void, blood at meatus | *Hematuria, dysuria, inability to void, blood at meatus | ||
*Vaginal bleeding | *Vaginal bleeding | ||
| Line 13: | Line 15: | ||
*High-riding or detached prostate | *High-riding or detached prostate | ||
**Associated w/ complete posterior urethral disruption | **Associated w/ complete posterior urethral disruption | ||
==Differential Diagnosis== | |||
{{Lower GU trauma DDX}} | |||
==Management== | ==Management== | ||
| Line 24: | Line 29: | ||
**Bladder filling with extravasation - partial tear | **Bladder filling with extravasation - partial tear | ||
=== | ===Management=== | ||
*Posterior urethral injury | *Posterior urethral injury | ||
**Suprapubic cathether placement | **Suprapubic cathether placement | ||
Revision as of 03:40, 4 January 2015
Background
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
Clinical 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
Differential Diagnosis
Genitourinary Trauma
- Urinary system
- Genital
- Other
- Child abuse
- Pelvic fracture (often accompanies)
- Sexual assault
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
Management
- Posterior urethral injury
- Suprapubic cathether placement
- Surgery is usually performed weeks later
- Anterior urethral injury
- Penetrating injuries require surgical exploration and repair