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Urethral Trauma, Emergency Medicine

Amanda Jillian-Lamond Holden Reviewed 06/2017
 


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 associa...

Diagnosis

Signs and Symptoms

  • Males:

    • Blood at the urethral meatus

    • Gross hematuria

  • Females:

    • Blood in the vaginal vault

    • Gross hematuria

History

Trauma to pelvic area 

Physical Exam

  • Exam of the torso and pelvis dur...

Treatment

Pre-Hospital

Pre-hospital trauma protocols 

Initial Stabilization/Therapy

Stabilization of multiple traumas takes precedence. 

Ed Treatment/Procedures

  • Urethral contusions, lacerations, and avulsi...

Follow-Up

Disposition

Admission Criteria

  • Concurrent traumatic injuries

  • Need for emergent operative management of urethral, penile, or bladder injuries

  • Partial lacerations:

    • Managed with urethral or suprapub...

Pearls and Pitfalls

  • Consult urology before attempting to insert a Foley in a trauma patient in whom urethral injury is highly suspected.

  • Passing a Foley catheter against resistance could convert a part...

Additional Reading

  • Goldman  SM, Sandler  CM, Corriere  JN Jr., et al. Blunt urethral trauma: A unified, anatomical mechanical classification. J Urology.  1997;157:85–89.

  • Marx  JA, Hockberger  RS, ...

Codes

ICD9

  • 665.50 Other injury to pelvic organs, unspecified as to episode of care or not applicable

  • 867.0 Injury to bladder and urethra, without mention of open wound into cavity

  • 867.1 Injury to bladder...

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