Urethral trauma: Difference between revisions
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{{Lower GU trauma DDX}} | {{Lower GU trauma DDX}} | ||
== | ==Diagnosis== | ||
===Imaging=== | ===Imaging=== | ||
*Retrograde urethrogram | *Retrograde urethrogram | ||
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**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 03:54, 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
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