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Urethral Trauma

Urethral Trauma is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Blood at the urethral meatus, a palpable full bladder, inability to void, and/or gross hematuria are common findings with urethral trauma.
  • Found in 14% of pelvic fractures
  • High association with bilateral pubic rami fractures (aka, straddle fractures)
  • Females: Urethral injuries are rare likely due to short, unexposed, and mobile urethras.
  • Girls <17 yr old: Higher injury rate likely from a more flexible pelvic ring
  • Bladder neck most commonly injured location.
  • Males: The urethra is divided into 2 sections.
  • Posterior urethra:
    • More commonly injured (∼90%)
    • Prostatic portion
    • Membranous
  • Anterior urethra:
    • Injuries are rare
    • Bulbar
    • Penile
  • Posterior urethra injuries comprise up to 90% of trauma:
    • Type 1: Urethra stretched but not ruptured
    • Type 2: Prostatic/membranous portions disrupted (either partially or completely); urogenital diaphragm intact
    • Type 3: Urethral disruption both proximal and distal to the genitourinary diaphragm

Etiology

  • Females:
    • Rare with pelvic fractures
    • Straddle injuries
    • Childbirth or vaginal surgery
    • Sexual trauma/abuse
  • Males:
    • More common with pelvic fractures
    • More common with straddle injuries
    • Penetrating trauma, mutilation
    • Sexual activity/instrumentation

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Citation

Rosen, Peter, et al., editors. "Urethral Trauma." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307263/all/Urethral_Trauma.
Urethral Trauma. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307263/all/Urethral_Trauma. Accessed April 23, 2019.
Urethral Trauma. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307263/all/Urethral_Trauma
Urethral Trauma [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307263/all/Urethral_Trauma.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Urethral Trauma ID - 307263 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307263/all/Urethral_Trauma PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -