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
• Lateral compression with vaginal vault penetration

 

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
• If there is no extravasation, a gentle catheterisation can be attempted. Do not perform multiple attempts. Any concerns, revert to performing a suprapubic catheterisation.
• 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.

Supra pubic catheters must be placed cephalad the the position of the symphysis when closed. Ultrasound can aid in placement. Call Urology (or General Surgery if not locally available) if concerns regarding safety of insertion.

Disposition – interhospital transfer guidelines

urethral