Urethral trauma: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===Imaging=== | ===Imaging=== | ||
*Standard "trauma CT" is likely to miss urethral trauma<ref>Lawson CM, Daley BJ, Ormsby CD, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. Feb, 2011;70:452-6.</ref> | |||
*Retrograde urethrogram | *Retrograde urethrogram | ||
**Must perform before catheterization to prevent further urethral injury | **Must perform before catheterization to prevent further urethral injury | ||
Revision as of 19:17, 16 June 2015
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 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
Diagnosis
Imaging
- 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 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