Urethral trauma - Revision history

Thomaslterman: /* Evaluation */

2023-09-12T15:29:03Z

Evaluation

← Older revision		Revision as of 15:29, 12 September 2023
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	**Must perform before catheterization to prevent further urethral injury; inflate balloon with 2-3ml of saline to minimize displacement		**Must perform before catheterization to prevent further urethral injury; inflate balloon with 2-3ml of saline to minimize displacement
	**20-60 mL of water soluble contrast in toomey syringe		**20-60 mL of water soluble contrast in toomey syringe
	***Can mix contrast with lubricating jelly in 1:1 ratio to minimize leakage.<ref>https://www.emrap.org/episode/trauma-em-fundamentals/urogenital</ref>		***Can mix contrast with lubricating jelly in 1:1 ratio to minimize leakage.<ref>https://www.emrap.org/episode/trauma-em-fundamentals/urogenital 12:40</ref>
	**Stretch penis perpendicularly across patient's thigh to unfold urethra.		**Stretch penis perpendicularly across patient's thigh to unfold urethra.
	**Inject 20-60 cc ''slowly'' into urethra (to prevent venous intravasation) while putting pressure on the glans to prevent leakage, shoot KUB during last 10 mL		**Inject 20-60 cc ''slowly'' into urethra (to prevent venous intravasation) while putting pressure on the glans to prevent leakage, shoot KUB during last 10 mL

2023-09-12T15:28:25Z

Evaluation

← Older revision		Revision as of 15:28, 12 September 2023
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	**Must perform before catheterization to prevent further urethral injury; inflate balloon with 2-3ml of saline to minimize displacement		**Must perform before catheterization to prevent further urethral injury; inflate balloon with 2-3ml of saline to minimize displacement
	**20-60 mL of water soluble contrast in toomey syringe		**20-60 mL of water soluble contrast in toomey syringe
			***Can mix contrast with lubricating jelly in 1:1 ratio to minimize leakage.<ref>https://www.emrap.org/episode/trauma-em-fundamentals/urogenital</ref>
	**Stretch penis perpendicularly across patient's thigh to unfold urethra.		**Stretch penis perpendicularly across patient's thigh to unfold urethra.
	**Inject 20-60 cc ''slowly'' into urethra (to prevent venous intravasation) while putting pressure on the glans to prevent leakage, shoot KUB during last 10 mL		**Inject 20-60 cc ''slowly'' into urethra (to prevent venous intravasation) while putting pressure on the glans to prevent leakage, shoot KUB during last 10 mL

2023-03-29T18:18:48Z

← Older revision		Revision as of 18:18, 29 March 2023
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	==Background==		==Background==
	[[File:Female and Male Urethra.jpg\|thumb\|Female (a) and male (b) urethra.]]		[[File:Female and Male Urethra.jpg\|thumb\|Female (a) and male (b) urethra.]]
			[[File:Gray1142.png\|thumb\|The human male urethra laid open on its anterior (upper) surface.]]
			[[File:Gray1155.png\|thumb\|Transverse section of the penis.]]
	*Commonly result of blunt trauma		*Commonly result of blunt trauma
	*Missed or inadequately managed injuries can result in strictures and recurrent urologic procedures		*Missed or inadequately managed injuries can result in strictures and recurrent urologic procedures

2023-03-29T18:16:17Z

Background

← Older revision		Revision as of 18:16, 29 March 2023
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	==Background==		==Background==
			[[File:Female and Male Urethra.jpg\|thumb\|Female (a) and male (b) urethra.]]
	*Commonly result of blunt trauma		*Commonly result of blunt trauma
	*Missed or inadequately managed injuries can result in strictures and recurrent urologic procedures		*Missed or inadequately managed injuries can result in strictures and recurrent urologic procedures

2023-03-29T18:13:33Z

Management

← Older revision		Revision as of 18:13, 29 March 2023
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	*Anterior urethral injury		*Anterior urethral injury
	**Penetrating injuries require surgical exploration and repair		**Penetrating injuries require surgical exploration and repair

			==Disposition==

	==See Also==		==See Also==

2023-03-03T21:17:37Z

Evaluation

← Older revision		Revision as of 21:17, 3 March 2023
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	*Standard "trauma CT" is likely to miss urethral trauma<ref>Lawson CM, Daley BJ, Ormsby CD, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. Feb, 2011;70:452-6.</ref>		*Standard "trauma CT" is likely to miss urethral trauma<ref>Lawson CM, Daley BJ, Ormsby CD, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. Feb, 2011;70:452-6.</ref>
	*Retrograde urethrogram		*Retrograde urethrogram
	**Must perform before catheterization to prevent further urethral injury		**Must perform before catheterization to prevent further urethral injury; inflate balloon with 2-3ml of saline to minimize displacement
	**60 mL of water soluble contrast in toomey syringe		**20-60 mL of water soluble contrast in toomey syringe
	**Stretch penis perpendicularly across patient's thigh to unfold urethra.		**Stretch penis perpendicularly across patient's thigh to unfold urethra.
	**Inject 60 cc ''slowly'' into urethra (to prevent venous intravasation) while putting pressure on the glans to prevent leakage, shoot KUB during last 10 mL		**Inject 20-60 cc ''slowly'' into urethra (to prevent venous intravasation) while putting pressure on the glans to prevent leakage, shoot KUB during last 10 mL
	**No bladder filling with extravasation - complete tear		**No bladder filling with extravasation - complete tear
	**Bladder filling with extravasation - partial tear		**Bladder filling with extravasation - partial tear

2019-11-09T18:37:07Z

Clinical Features

← Older revision		Revision as of 18:37, 9 November 2019
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	*High-riding or detached prostate		*High-riding or detached prostate
	**Associated with complete posterior urethral disruption		**Associated with complete posterior urethral disruption
			**"ATLS ® -10 has now removed rectal examination for this purpose due to the poor sensitivity (2%) demonstrated for this maneuver." <ref>[https://www.ncbi.nlm.nih.gov/pubmed/30711226 Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.]</ref>

	==Differential Diagnosis==		==Differential Diagnosis==

2016-07-26T09:40:31Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 09:40, 26 July 2016
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	{{Lower GU trauma DDX}}		{{Lower GU trauma DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*Standard "trauma CT" is likely to miss urethral trauma<ref>Lawson CM, Daley BJ, Ormsby CD, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. Feb, 2011;70:452-6.</ref>		*Standard "trauma CT" is likely to miss urethral trauma<ref>Lawson CM, Daley BJ, Ormsby CD, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. Feb, 2011;70:452-6.</ref>
	*Retrograde urethrogram		*Retrograde urethrogram

2016-07-14T00:10:07Z

Text replacement - " w/ " to " with "

← Older revision		Revision as of 00:10, 14 July 2016
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	*Perineal or scrotal hematoma		*Perineal or scrotal hematoma
	*High-riding or detached prostate		*High-riding or detached prostate
	**Associated w/ complete posterior urethral disruption		**Associated with complete posterior urethral disruption

	==Differential Diagnosis==		==Differential Diagnosis==

2016-07-13T18:20:50Z

Text replacement - "==Clinical Presentation==" to "==Clinical Features=="

← Older revision		Revision as of 18:20, 13 July 2016
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	**Often accompanies pelvic fracture		**Often accompanies pelvic fracture

	==Clinical ~~Presentation~~==		==Clinical Features==
	*Hematuria, dysuria, inability to void, blood at meatus		*Hematuria, dysuria, inability to void, blood at meatus
	*Vaginal bleeding		*Vaginal bleeding