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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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