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[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

Differential Diagnosis

Genitourinary trauma

Evaluation

  • Standard "trauma CT" is likely to miss urethral trauma[2]
  • 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. Lawson CM, Daley BJ, Ormsby CD, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. Feb, 2011;70:452-6.