Urethral trauma

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
  • 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."

Differential Diagnosis

Genitourinary Trauma

• Urinary system
  • Renal trauma
  • Ureter trauma
  • Bladder trauma
  • Urethral trauma
    • Traumatic foley catheter removal
• Genital
  • Penile trauma
    • Traumatic foley catheter removal
  • Testicular trauma
  • Vaginal trauma
• Other
  • Child abuse
  • Pelvic fracture (often accompanies)
  • Sexual assault

Evaluation

• Standard "trauma CT" is likely to miss urethral trauma
• 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

• Genitourinary trauma
• Traumatic Foley Catheter Removal