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Urethral Trauma

Reported Trauma to Urethra


Presentation

  • RUGs did not appear to be needed in patients with no disruption of the pubic symphysis on initial pelvis X-ray or where no signs of urethral injury are present.[ncbi.nlm.nih.gov]
Animal Bite
  • Etiologies include animal bites [4], gunshot and stab wounds. Insertion of foreign bodies is another rare cause of anterior injury.[emedicine.medscape.com]
  • Other common types of injuries include Animal bites Bruises Burns Dislocations Electrical injuries Fractures Sprains and strains Bleeding (Medical Encyclopedia) Crush injury (Medical Encyclopedia) Cuts and puncture wounds (Medical Encyclopedia) Electrical[icdlist.com]
  • Gomes CM, Ribeiro-Filho L, Giron AM et el: Genital trauma due to animal bites. J Urol 2001; 165 : 80. Jeong JH, Shin HJ, Woo SH et al: A new repair technique for penile paraffinoma: bilateral scrotal flaps. Ann Plast Surg 1996; 37 : 386.[auanet.org]
Difficulty Walking
  • Ultimately the patient has difficulty walking due to the size and weight of the testicular swelling. Scrotal lymphedema is most likely to occur in obese men.[tuh.templehealth.org]
Military Personnel
  • Wilcox SL, Redmond S, Hassan AM: Sexual functioning in military personnel: Preliminary estimates and predictors. J Sex Med 2014; 11 : 2537. Frappell-Cooke W, Wink P, Wood A: The psychological challenge of genital injury.[auanet.org]
Chronic Cough
  • Your recognised location is United States (US) More: Guidance Chronic cough in a child Source: Finnish Medical Society Duodecim This article is freely available only to users in the UK.[evidence.nhs.uk]
Acne Vulgaris
  • Abdominal aortic aneurysm Abdominal examination Abdominal hernias About the USMLE Step 2 CS Achalasia Achilles tendon rupture Acid-base disorders Acne vulgaris Acoustic neuroma Acquired diaphragmatic hernias Acromegaly Actinomycosis Acute abdomen Acute[amboss.com]
Hematuria
  • Males: Blood at the urethral meatus Gross hematuria Females: Blood in the vaginal vault Gross hematuria Exam of the torso and pelvis dur...[5minuteconsult.com]
  • Signs and Symptoms of an Anterior Urethral Injury Bloody discharge from the meatus Hematuria A Hematoma is normally confined to the perineum and penile shaft. If Buck's fascia is torn, the hematoma can extend into the scrotum.[urology-textbook.com]
  • The latter 14 were divided into two groups 5 cases with macroscopic hematuria and 7 with microscopic hematuria with 2 cases which had no hematuria.[east.org]
  • Incidence and magnitude of catheter-induced hematuria. Am J Emerg Med 1986;4:14–16.[lifeinthefastlane.com]
  • This can cause: Swelling Inflammation Infection Pain in the belly Other signs of urethral trauma are: Not being able to pass urine Urine building up in the bladder Blood in the urine (" hematuria ") For males, the most common sign of a problem is blood[urologyhealth.org]
Dysuria
  • Children who have urethritis may present with irritative voiding symptoms, such as dysuria, urgency, or frequency; possible urethral discharge; initial hematuria; or blood spotting on the underwear.[pedsinreview.aappublications.org]
  • Dysuria, urinary urgency and suprapubic discomfort can ensue in the chronic stages of incomplete urethral injury due to complicating strictures.[radiopaedia.org]
  • Signs : dysuria, hematuria, anuria, abdominal distension, perineal or preputial swelling. Treatment : correct metabolic anomalies prior to definitive treatment. Many lacerations can be managed by urinary diversion.[vetstream.com]
  • […] on fixed membranous and mobile prostatic urethra anterior: straddle injury causing crush injury to bulbar urethra against pubic rami iatrogenic: instrumentation, penile fracture Presentation History mechanism of injury hematuria, blood on underwear dysuria[medbullets.com]
Urethral Discharge
  • For instance, the doctor will be able to readily observe redness (or urethral discharge) and find out if one or more areas are hard or swollen.[healthline.com]
  • Children who have urethritis may present with irritative voiding symptoms, such as dysuria, urgency, or frequency; possible urethral discharge; initial hematuria; or blood spotting on the underwear.[pedsinreview.aappublications.org]
  • Urethral discharge is highly associated with urethritis. 19 In men, urethral discharge and dysuria are the most common symptoms of sexually transmitted urethritis.[aafp.org]
  • discharge culture (Medical Encyclopedia) Urethral stricture (Medical Encyclopedia) Urethritis (Medical Encyclopedia) Urinary Retention - NIH (National Institute of Diabetes and Digestive and Kidney Diseases) [ Read More ] Wounds and Injuries Also called[icdlist.com]
  • Complications of Urethral Strictures Complications of stricture disease are: urethral discharge urinary tract infection cystitis (inflammation of the bladder) chronic prostatitis (inflammation of the prostate gland) or epididymitis (inflammation of the[urology.wustl.edu]
Urethral Bleeding
  • Even urethral bleeding may take 1 h to become apparent.[onlinelibrary.wiley.com]
  • EXAMINATION – URETHRAL BLEEDING 15. EXAMINATION – PENILE FRACTURE 16.[slideshare.net]
  • Physical examination Common symptoms include urethral bleeding, bruising along the flank, urinary retention, lower abdominal distention and pain, and swelling and edema of the genitalia.[medical-dictionary.thefreedictionary.com]
  • bleeding, prostate displacement, rectal injury (lower GU injury).[east.org]
Macroscopic Hematuria
  • Retrograde cystogram was performed whether microscopic or macroscopic hematuria was present.[east.org]
  • hematuria in a patient with a pelvic fracture Penetrating trauma close to the bladder Classic triad: — hematuria — suprapubic pain — inability to void Pregnant women and intoxicated patients (full bladders!)[lifeinthefastlane.com]

Workup

  • Peterson NE III Retrospective review of 157 penetrating; 225 blunt pts Workup consisted of IVP, retrograde cysto- urethrography; occasional arteriography and CT.[east.org]
  • Figure 20b Conclusion CT urography has become widely accepted as the new first-line imaging modality in the workup of hematuria in adult patients and in the initial staging and surveillance of UCC.[pubs.rsna.org]

Treatment

  • Such conditions have been found to significantly deteriorate quality of life and complicate subsequent treatments. Only optimal prevention associated with appropriate treatment allows for the long-term continuation of such bladder management.[ncbi.nlm.nih.gov]
  • The treatment for anterior injuries was conservative in 193 patients and surgical in 62.[onlinelibrary.wiley.com]
  • Meanwhile, the controversy surrounding immediate vs delayed treatment of urethral injuries is still unresolved.[kelmacmedical.us]

Prognosis

  • Prognosis Men with urethral injuries have an excellent prognosis when managed correctly. Problems arise if a urethral injury is unrecognized and the urethra is further damaged by attempts at blind catheterization.[emedicine.medscape.com]
  • PROGNOSIS • WITH PROPER MGT PROGNOSIS IS EXCELLENT6 • UNRECOGNIZED URETHRAL INJURY HOWEVER LEADS TO HIGHER INCIDENCE OF COMPLICATIONS 29. FUTURE TRENDS • USE OF MAGNETIC CATHETERS FOR EARLY REALIGNMENT OF THE URETHRA 30.[slideshare.net]
  • Treatment and prognosis Treatment consists from urinary diversion (e.g. suprapubic catheter ) to primary or delayed urethral anastomosis depending on the severity (i.e. tear vs. complete rupture) of the injury.[radiopaedia.org]
  • Prognosis : guarded. Pathogenesis Etiology RTA/HBC with pelvic fracture (usually rupture at pelvic or penile site). Urethral obstruction (usually perineal site). Iatrogenic injury through catheterization (usually perineal site). Bites.[vetstream.com]

Etiology

  • Etiology As with many traumatic events, the etiology of a urethral injury can be classified as blunt or penetrating.[emedicine.medscape.com]
  • Result:- Most common etiology of urethral injury and stricture urethra was trauma with membranous urethra being the most common site.[webmedcentral.com]
  • Pathogenesis Etiology RTA/HBC with pelvic fracture (usually rupture at pelvic or penile site). Urethral obstruction (usually perineal site). Iatrogenic injury through catheterization (usually perineal site). Bites. Ballistic injuries.[vetstream.com]
  • Introduction Genitourinary trauma involves kidney, bladder, and/or urethra 80% is from blunt trauma (MVCs, assaults, falls, crush) vs 20% penetrating (GSW/SW) Blunt trauma to genitourinary organs is associated with pelvic fracture in 97% cases Urethral injury etiology[medbullets.com]

Epidemiology

  • INTRODUCTION • EPIDEMIOLOGY – IT IS THE COMMONEST CAUSE OF URETHRAL STRICTURE IN NIGERIA1,2 – MAKES UP MAJORITY OF GU INJURIES4,5 – 10% OF PELVIC FRACTURES ASSOC WITH URETHRAL INJURY6 5. RELEVANT ANATOMY 6.[slideshare.net]
  • Relevant pathophysiological background and epidemiology are reviewed, necessary diagnostic testing recommended, and detailed medical, surgical and endourological management approaches have been provided.[books.google.ro]
  • Iatrogenic urethral injuries also occur after radical prostatectomy, pelvic radiotherapy, and other abdominopelvic surgery. [6] Epidemiology Posterior urethral injuries are most commonly associated with pelvic fracture, with an incidence of 5%-10%.[emedicine.medscape.com]
  • Paparel P, N’Diaye A, Laumon B et al (2006) The epidemiology of trauma of the genitourinary system after traffic accidents: analysis of a register of over 43,000 victims. BJU Int 97:338–341 CrossRef PubMed Google Scholar 6.[link.springer.com]
Sex distribution
Age distribution

Pathophysiology

  • The text is organized by pathophysiology rather than organ system, allowing the reader to develop approaches to the care of patients with acute urological conditions based on mechanism of disease.[books.google.ro]
  • Pathophysiology Urine leaks into periurethral tissue/abdomen causing cellulitis/peritonitis Peritonitis. Often leukocytosis. Dehydration, hypoproteinemia Hypoproteinemia, hypoglycemia Hypoglycemia. Azotemia Azotemia in some cases.[vetstream.com]
  • Pathophysiology Injury to the posterior urethra occurs when a shearing force is applied at the prostatomembranous junction in blunt pelvic trauma. The prostatic urethra is fixed in position because of the attachments of the puboprostatic ligaments.[emedicine.medscape.com]

Prevention

  • Only optimal prevention associated with appropriate treatment allows for the long-term continuation of such bladder management.[ncbi.nlm.nih.gov]
  • From TraumaWiki.com Background Trauma to the male urethra must be quickly diagnosed and promptly treated to prevent serious long-term complications.[traumawiki.opus12.org]
  • Screening and prevention of colorectal cancer Source: Finnish Medical Society Duodecim This article is freely available only to users in the UK.[evidence.nhs.uk]
  • In this connection, primary urological treatment should be directed at preventing early complications and minimizing the risk of the aforementioned potential problems.[kelmacmedical.us]

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