Male urethral Trauma

The important factors that need to be considered in the management of the Ijury in the Immediate settings include:
Mechanism of injury
Has the patient voided? Haematuria? Increase in swelling after voiding? (extravasation)

Examination
Signs of shock?
Perineum – extent of haematoma. Confined to perineum/penile shaft then Buck’s fascia intact. If more extensive then suggests rupture of Bucks fascia and will be confined by Colles fascia
Blood at urethral meatus?–present in 75% of anterior urethral trauma
PR – prostate should feel normal
Is bladder distended?

Investigation
Usual trauma investigations including bloods.

Injury may be contusion or laceration of the urethra.
Urethrography – if urethra intact this is a contusion injuries and the haematoma usually resolves without complication. May wish to prescribe analgesia and antibiotics as prone to infection. Patient should be encouraged to void.

If laceration then needs catheter either single attempt urethrally or through the abdomen- probably best done under GA in child.
Laceration injuries may allow extravasation of urine which can extend along penile shaft, and up abdo wall, extension limited by Colles fascia. This may become infected and require draiage.

Will need further assessment of urethra with urethrogram (up and down) in 4/52.
Most common problem is stricture formation at site of injury. The majority of which do not require surgical intervention.
Those that do require surgical intervention should have delayed repair >3/12 after injury.
Options include simple debridement and anastomosis if short stricture (<1cm). Longer strictures will require grafts or flaps to bridge deficiency.

What is urethrogram?
12/14ch catheter in fossa navicularis ( in the penile opening). 2mls in balloon to occlude urethra. 20 mls of undiluted contrast injected slowly and films taken at 30 degree oblique angle.