Urethral trauma

Due to anatomical differences, urethral trauma is common in men, but can be seen in women with severe pelvis trauma

Suspect urethral injury in patient with

  • Anterior pelvis fractures
  • Straddle injuries
  • Penetrating injuries adjacent to urethra

 

Clinical signs

  • Inability to void
  • Haematuria
  • Blood at urethral meatus
  • Perineal bruising
  • High riding prostate (though this is an unreliable sign)

 

Investigations

 

Retrograde urethrogram performed in the resus room

  • With the patient supine, a paediatric (eg: 8F) urinary catheter is advanced (using aseptic technique) into the urethra just far enough that the balloon portion is inside the urethra (to the “fossa navicularis”)
  • The balloon is inflated with 0.5-1ml water (do NOT overinflate)
  • 20ml of contrast is injected into the catheter while an oblique xray of the pelvis is obtained
  • Extravasation of contrast indicates urethral injury, urology should be consulted. The patient will likely require a suprapubic catheter insertion
    • There is some controversy regarding the safety of passing an IDC in patients with urethral trauma: discuss all cases with urology first

 

If there is concern regarding bladder injury, provided there is no radiological evidence of urethral injury and a urinary catheter passes easily into the bladder, a retrograde cystogram (CT or plain film) can be performed.

 

Disposition – interhospital transfer guidelines

urethral

 

About this guideline

Published: February 2018

Author: Emma Batistich

Approved by: Northern Region Trauma Network, ADHB, WDHB, CMDHB, NDHB

Review due: 2 years