0071643192.pdf

Urethral

MECHANISMS

■ Posterior urethral injuries typically result from pelvic fractures.

■ Anterior urethral injuries: Direct blow to the urethra, instrumentation, and

penile fractures

SYMPTOMS/EXAM

■ Posterior urethral injuries: Perineal hematoma and high-riding prostate on

rectal exam

■ Anterior urethral injuries: “Butterfly” perineal hematoma

■ In females, urethral injuries are often associated with vaginal bleeding.

DIAGNOSIS

Retrograde urethrogram (RUG) should always be performed before placing a

Foley in the setting of meatal blood or a high-riding prostate and suspected

pelvic fracture (see Figure 3.18).

TREATMENT

■ Contusions heal with or without catheter placement.

■ Partial lacerations are managed with a catheter placed by urologist.

■ Complete lacerations are managed surgically.

■ It is not inappropriate to conservatively manage urethral injuries with

suprapubic cystostomy.

■ A Foley should only be placed when the path of the urethra is still intact,

and is best placed by a urologist under direct visualization via cystoscopy.

TRAUMA

Blood at urethral meatus

mandates RUG before Foley

placement.

FIGURE 3.18. Retrograde urethrogram positive for urethral injury.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency

Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:1221.)