Urethral trauma: Difference between revisions
No edit summary |
|||
(11 intermediate revisions by 4 users not shown) | |||
Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Commonly result of blunt trauma | |||
*Missed or inadequately managed injuries can result in strictures and recurrent urologic procedures | |||
===Types=== | ===Types=== | ||
*Anterior | *Anterior | ||
Line 6: | Line 8: | ||
*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 | **Often accompanies pelvic fracture | ||
==Clinical | ==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 | **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}} | ||
== | ==Evaluation== | ||
*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 | **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== | |||
*Posterior urethral injury | *Posterior urethral injury | ||
**Suprapubic cathether placement | **Suprapubic cathether placement | ||
Line 37: | Line 40: | ||
==See Also== | ==See Also== | ||
[[ | *[[Genitourinary trauma]] | ||
*[[Traumatic Foley Catheter Removal]] | |||
==References== | |||
<references/> | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category: | [[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
- Urinary system
- Genital
- Other
- Child abuse
- Pelvic fracture (often accompanies)
- Sexual assault
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
- ↑ 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
- ↑ Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.
- ↑ Lawson CM, Daley BJ, Ormsby CD, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. Feb, 2011;70:452-6.