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 fracture


==Clinical Presentation==
==Clinical Features==
*Hematuria, dysuria, inability to void, blood at meatus
*Hematuria, dysuria, inability to void, blood at meatus
*Vaginal bleeding
*Vaginal bleeding
*Perineal or scrotal hematoma
*Perineal or scrotal hematoma
*High-riding or detached prostate
*High-riding or detached prostate
**Associated w/ complete posterior urethral disruption
**Associated with complete posterior urethral disruption
**"ATLS ® -10 has now removed rectal examination for this purpose due to the poor sensitivity (2%) demonstrated for this maneuver." <ref>[https://www.ncbi.nlm.nih.gov/pubmed/30711226 Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.]</ref>


==Differential Diagnosis==
==Differential Diagnosis==
{{Lower GU trauma DDX}}
{{Lower GU trauma DDX}}


==Management==
==Evaluation==
===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
**60 mL of water soluble contrast in toomey syringe
**60 mL of water soluble contrast in toomey syringe
**Stretch penis perpendicularly across pt's thigh to unfold urethra.
**Stretch penis perpendicularly across patient'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
**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
**No bladder filling with extravasation - complete tear
**Bladder filling with extravasation - partial tear
**Bladder filling with extravasation - partial tear


===Management===
==Management==
*Posterior urethral injury
*Posterior urethral injury
**Suprapubic cathether placement
**Suprapubic cathether placement
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==See Also==
==See Also==
[[GU Trauma]]
*[[Genitourinary trauma]]
*[[Traumatic Foley Catheter Removal]]
 
==References==
<references/>


[[Category:Trauma]]
[[Category:Trauma]]
[[Category:GU]]
[[Category:Urology]]

Revision as of 18:37, 9 November 2019

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 fracture

Clinical Features

  • Hematuria, dysuria, inability to void, blood at meatus
  • Vaginal bleeding
  • Perineal or scrotal hematoma
  • High-riding or detached prostate
    • Associated with complete posterior urethral disruption
    • "ATLS ® -10 has now removed rectal examination for this purpose due to the poor sensitivity (2%) demonstrated for this maneuver." [2]

Differential Diagnosis

Genitourinary Trauma

Evaluation

  • Standard "trauma CT" is likely to miss urethral trauma[3]
  • Retrograde urethrogram
    • Must perform before catheterization to prevent further urethral injury
    • 60 mL of water soluble contrast in toomey syringe
    • Stretch penis perpendicularly across patient'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

See Also

References

  1. 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
  2. Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.
  3. Lawson CM, Daley BJ, Ormsby CD, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. Feb, 2011;70:452-6.