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Urethral Injury

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Topic updated on 09/26/16 3:18pm

Snapshot
  • A 26-year-old male is brought to the emergency department after a motor vehicle accident. He is conscious and complaining of severe pain. During the secondary survey blood is noted at the tip of the penis. Pelvic radiograph reveals a fractured pelvis.
Introduction
  • Urethral injuries are uncommon, more common in males than females
    • female urethra much shorter than male
  • Can occur as result of straddle-type falls (anterior urethral injury) or pelvic fractures (posterior urethral injury)
  • Posterior urethral trauma in males can result in complete tear of urethra just below prostate
Presentation
  • Symptoms
    • inability to urinate, urinary retention
    • hematuria
    • abdominal pain
  • Physical exam
    • evidence of blood at the urethral meatus
    • swelling and bruising of penis, scrotum, or perineum
    • leakage of urine into tissues surrounding urethra may result in swelling and inflammation
Evaluation
  • Pelvic radiograph with urethrography PRIOR to insertion of transurethral bladder catheter 
Treatment
  • Depending on severity, can be allowed to heal following careful placement of transurethral bladder catheter
  • Severe cases may necessitate surgical repair
  • Urinary diversion with suprapubic catheter in case of complete urethral tear
Prognosis, Prevention, and Complications
  • Urethral injury can lead to scarring resulting in urethral stricture that can slow or block urine flow
  • 50% of men with urethral injury secondary to pelvic fracture will also suffer from erectile dysfunction due to nerve injury

 



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(M2.RL.45) A 26-year-old male is hit by a car while riding his bike to work. On presentation to the emergency room, the trauma team is activated. On physical exam he has abrasions on the face, hands, and bruising over both iliac crests. His blood pressure is 90/55mmHg and pulse rate is 110 bpm. Scrotal and perineal ecchymosis are noted. Two large bore IV cannulas are inserted and he is given 3L of Ringer's lactate and his blood pressure is re-measured: 120/71 (HR 93). A pelvic binder is applied, and orthopedic surgery and trauma surgery are consulted. What is the most appropriate next step? Topic Review Topic

1. Insert a foley catheter
2. Administer 2L of Ringer's lactate
3. Head CT
4. Retrograde urethrogram
5. Immediate surgery

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