Urethral trauma: Difference between revisions
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==Background== | ==Background== | ||
*Commonly result of blunt trauma | |||
*Missed or inadequately managed injuries can result in strictures and recurrent urologic procedures | |||
===Types=== | ===Types=== | ||
*Anterior | *Anterior | ||
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*Posterior | *Posterior | ||
**Located in the membranous and prostatic urethra | **Located in the membranous and prostatic urethra | ||
**Due to blunt trauma from massive deceleration | **Due to blunt trauma from massive deceleration<ref>Andrich DE, Day AC, Mundy AR. Proposed mechanisms of lower urinary tract injury in fractures of the pelvic ring. BJU Int. Sept. 2007;100:567-73</ref> | ||
**Often accompanies pelvic fx | **Often accompanies pelvic fx | ||
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*Anterior urethral injury | *Anterior urethral injury | ||
**Penetrating injuries require surgical exploration and repair | **Penetrating injuries require surgical exploration and repair | ||
==References== | |||
<references/> | |||
==See Also== | ==See Also== | ||
Revision as of 19:15, 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
- 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
References
- ↑ Andrich DE, Day AC, Mundy AR. Proposed mechanisms of lower urinary tract injury in fractures of the pelvic ring. BJU Int. Sept. 2007;100:567-73