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Urethral Injury

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Topic updated on 08/09/17 7:00pm

Snapshot
  • A 25-year old man presents to the emergency room after a motor vehicle accident. He reports severe pain in his groin. On physical exam, blood is noted at the tip of the penis. Pelvic radiograph reveals a fractured pelvis, and he is sent for a retrograde urethrogram.
Introduction
  • Clinical definition
    • damage to the urethra
  • Epidemiology
    • demographics
      • more common in men
        • urethra is shorter and more mobile (no attachments to the pubic bone) in women
  • Etiology
    • 80% of cases from blunt trauma
      • straddle-type falls or direct blows
        • anterior urethral injury
      • pelvic fractures
        • most often from motor vehicle accidents
        • posterior urethral injury
    • physical or sexual assault
  • Anatomy
    • male urethra is divided into anterior (bulbous and pendulous) and posterior (prostatic and membranous) urethra
  • Prognosis
    • rarely life-threatening
Presentation
  • Symptoms
    • primary symptoms
      • difficulty urinating
      • urinary retention
      • gross hematuria
      • lower abdominal pain
  • Physical exam
    • blood at urethral meatus
    • swelling or ecchymosis of penis, scrotum, or perineum
    • rectal exam
      • absent or abnormally positioned prostate (high riding prostate)
Imaging
  • Radiographs
    • indications
      • to evaluate for fractures
    • recommend views
      • pelvic
  • Retrograde urethrogram
    • indications
      • must be done prior to insertion of transurethral bladder catheter
Studies
  • Urinalysis
    • hematuria (gross or microhematuria)
  • Diagnostic criteria
    • retrograde urethrogram showing injury
Treatment
  • Non-operative
    • transurethral bladder catheter and monitor for healing
      • indications
        • if injury is not too severe to necessitate surgery
  • Operative
    • surgical repair
      • indications
        • severe injury
        • may require diverting urine from injury by placing a suprapubic catheter
Complications
  • Urinary stricture
  • Erectile dysfunction
    • incidence
      • 50% of those with urethral injury secondary to pelvic fracture


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Qbank (1 Questions)

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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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