Urethral Trauma Workup
- Author: James M Cummings, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS more...
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.
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.
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.
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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