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The long walk of urethral injuries

The urethra does not usually attract the interest of paediatricians during the initial management of a polytraumatised patient; so it is common that in patients with multiple trauma, especially those with pelvic fractures or perineal injuries, urologic lesions (present in 7.4–13.5% of paediatric pelvic trauma) are discovered when catheterisation cannot be performed or is extremely painful. Injuries of the anterior urethra (penile and bulbar) are caused by falls on the perineum (“straddle” falls); while injuries of the posterior urethra (membranous and prostatic) are associated with pelvic fractures, especially unstable ones (Malgaigne). The diagnosis and classification of these injuries are…

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Articles of Interest

A novel method to cease traumatic urethral bleeding

Urethral bleeding due to trauma often is a self-limiting complication. However, in massive cases, much is not found in the literature regarding management. In a young man with massive urethral bleeding due to iatrogenic trauma which didn’t respond to these methods, the bleeding stopped by gradually inflating the balloon of the catheter up to 4 mL.

An overview of urethral injury

Retrograde urethrogram (RUG) is the diagnostic imaging study of choice in the setting of suspected urethral injury. Partial disruption of the urethra is suggested with active extravasation of contrast with simultaneous bladder filling, while a complete disruption is suggested in the setting of contrast extravasation without visualization of contrast in the bladder. While the American Association for the Surgery of Trauma (AAST) staging of urethral injury remains the gold standard staging system, Chapple et al suggested a simpler, practical classification system based on RUG findings in their 2004 consensus statement on urethral injury. A RUG will help identify the location and extent of urethral injury and can be helpful in guiding subsequent management decisions.

Diagnostic and Management Strategies for Critical Care and Trauma Clinicians

Any type of trauma can affect the urethra; however, specific injury patterns affect the urethra at higher incidence. The majority of urethral trauma is caused by blunt injury, penetrating injury, and/or iatrogenic injury. Most major urethral injuries are due to blunt trauma caused by mechanisms such as motor vehicle collisions, kicks, or falls.

Genitourinary Trauma: Presentations, Evaluation, and Management Updates

Imaging of the urethra is indicated in all trauma patients presenting with blood at the urethral meatus, inability to void, or in whom there is concern for urethral injury. The absence of blood at the urethral meatus, gross hematuria, and pelvic fractures cannot exclude urethral injury. Additionally, female urethral injuries may present atypically as vaginal bleeding or incontinence and therefore may be easily overlooked.26 Imaging of the urethra is obtained by performing a retrograde urethrogram (RUG).

Podcast #206: Urethral Injuries

DDx for blood at urethral meatus includes: pelvic fracture, ruptured bladder, kidney laceration, penile trauma. Retrograde Urethrogram (RUG) must be performed before placing foley and is critical for diagnosis.

Straddle injuries to the bulbar urethra

Suprapubic cystostomy is associated with a lower stricture rate than urethral catheterization as primary management after straddle injury to the bulbar urethra. Stricture excision and re-anastomosis is associated with a lower recurrence rate than VIU as delayed management for strictures after straddle injury to the bulbar urethra.

The management of urethral trauma

Urethral trauma is relatively uncommon. It occurs more frequently in young males. Injuries to the a nterior urethra are typically caused by blunt trauma including 'straddle' injuries, athough penetrating injuries do occur. Posterior urethral injurines are usually due to pelvic fractures from automobile or industrial accidents and occur in 10% of patients with a pelvic fracture.

The Management of Urological Trauma Associated with Pelvic Fractures

Male and female patients suffering displaced anterior pelvic fractures or urethral injury have a high incidence of urinary and sexual dysfunction. All patients should be provided with a written information sheet on this issue.

Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians

Urologic trauma is a well-known cause of urethral injury with a range of management recommendations. Retrograde urethrogram remains the preferred initial diagnostic modality to evaluate a suspected urethral injury. The management thereafter varies based on mechanism of injury. Iatrogenic urethral injury is often caused by traumatic catheterization and is best managed by an attempted catheterization performed by an experienced clinician or suprapubic catheter to maximize urinary drainage.

Urethral Injury

Urethral injury is a relatively rare medical condition accounting for less than 1% of all emergency department visits in the United States. Injury patterns vary and encompass urethral crush, bruising, laceration, and transection. Urethral injuries are never life-threatening, but if left untreated can cause significant morbidity. While most injuries are iatrogenic, traumatic etiologies often caused by high energy mechanisms certainly do carry mortality threats. The injury extent and anatomical location are formative in the development of a management plan.