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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