Urethral Trauma Workup

  • Author: James M Cummings, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: Aug 3, 2011
 

Imaging Studies

These studies have become even more important as trauma services rely more on initial CT scanning as the major imaging modality. The "trauma" CT may well miss lower urinary tract injuries to the urethra and bladder and thus any suspicion for urethral injury should lead one to perform these studies in addition to any others.[5]

Retrograde urethrography

The retrograde urethrography is the standard imaging study for the diagnosis of urethral injury. It is performed using gentle injection of 20-30 mL of contrast into the urethra. Examination is made for extravasation, which pinpoints the existence and location of the urethral tear.

Cystography

The static cystography allows for concurrent bladder injury to be excluded in the acute setting. When a delayed repair is being considered, voiding cystography (performed through the suprapubic catheter) demonstrates the bladder neck and prostatic urethral anatomy and allows for proper surgical planning.

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Diagnostic Procedures

Cystoscopy can be a valuable adjunct in the evaluation of a male urethral injury. In the acute setting, the feasibility of early endoscopic realignment can be determined (see Treatment). In the delayed setting, the quality of the urethra can be evaluated for surgical repair. When cystoscopy is combined with retrograde urethrography and cystography, a more accurate estimation of stricture length can be made, facilitating decisions in operative strategy.

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Contributor Information and Disclosures
Author

James M Cummings, MD  Professor, Department of Surgery, Division of Urology, University of Missouri School of Medicine

James M Cummings, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, and Phi Beta Kappa

Disclosure: Urologic Specialists Ownership interest None

Specialty Editor Board

Daniel B Rukstalis, MD  Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group

Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science and American Urological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark Jeffrey Noble, MD  Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group

Disclosure: Nothing to disclose.

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor John Boullier, MD, to the development and writing of this article.

References

  1. Dixon CM. Diagnosis and acute management of posterior urethral disruptions. In: McAninch JW, ed. Traumatic and Reconstructive Urology. Philadelphia, Pa: WB Saunders; 1996:347-55.

  2. Andrich DE, Day AC, Mundy AR. Proposed mechanisms of lower urinary tract injury in fractures of the pelvic ring. BJU Int. Sept. 2007;100:567-73. [Medline].

  3. Mouraviev VB, Santucci RA. Cadaveric anatomy of pelvic fracture urethral distraction injury: most injuries are distal to the external urinary sphincter. J Urol. Mar 2005;173(3):869-72. [Medline].

  4. Kellner DS, Fracchia JA, Armenakas NA. Ventral onlay buccal mucosal grafts for anterior urethral strictures: long-term followup. J Urol. Feb 2004;171(2 Pt 1):726-9. [Medline].

  5. Lawson CM, Daley BJ, Ormsby CD, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. Feb, 2011;70:452-6. [Medline].

  6. Kommu SS, Illahi I, Mumtaz F. Patterns of urethral injury and immediate management. Curr Opin Urol. Nov 2007;17(6):383-9. [Medline].

  7. Mundy AR. The role of delayed primary repair in the acute management of pelvic fracture injuries of the urethra. Br J Urol. Sep 1991;68(3):273-6. [Medline].

  8. Webster GD, Mathes GL, Selli C. Prostatomembranous urethral injuries: a review of the literature and a rational approach to their management. J Urol. Nov 1983;130(5):898-902. [Medline].

  9. Koraitim MM. On the art of anastomotic posterior urethroplasty: a 27-year experience. J Urol. Jan 2005;173(1):135-9. [Medline].

  10. Cooperberg MR, McAninch JW, Alsikafi NF, Elliott SP. Urethral reconstruction for traumatic posterior urethral disruption: outcomes of a 25-year experience. J Urol. Nov 2007;178(5):2006-10; discussion 2010. [Medline].

  11. Jepson BR, Boullier JA, Moore RG, Parra RO. Traumatic posterior urethral injury and early primary endoscopic realignment: evaluation of long-term follow-up. Urology. Jun 1999;53(6):1205-10. [Medline].

  12. McAninch JW, Morey AF. Penile circular fasciocutaneous skin flap in 1-stage reconstruction of complex anterior urethral strictures. J Urol. Apr 1998;159(4):1209-13. [Medline].

  13. Morey AF, Hernandez J, McAninch JW. Reconstructive surgery for trauma of the lower urinary tract. Urol Clin North Am. Feb 1999;26(1):49-60, viii. [Medline].

 
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Urethrogram demonstrating partial urethral disruption.
Urethrogram demonstrating complete urethral disruption.
 
 
 
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