Urethral trauma
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
Presentation
- Hematuria, dysuria, inability to void, blood at meatus
- Vaginal bleeding
- Perineal hematoma
- High-riding or detached prostate
- Associated w/ complete posterior urethral disruption
Management
Imaging
- Retrograde urethrogram
- Must perform before catheterization to prevent further urethral injury
- 60 mL of water soluble contrast in toomey syringe
- Inject into urethra, shoot KUB during last 10 mL
- No bladder filling with extravasation - complete tear
- Bladder filling with extravasation - partial tear
Treatment
- Posterior urethral injury
- Suprapubic cathether placement
- Surgery is usually performed weeks later
- Anterior urethral injury
- Penetrating injuries require surgical exploration and repair