Smith's General Urology, 17e
Injuries to the Anterior Urethra
Sections: Etiology (Figure 1717), Pathogenesis
& Pathology, Contusion, Laceration, Clinical Findings, Symptoms, Signs, Laboratory
Findings, X-Ray Findings, Complications, Treatment, General Measures, Specific
Laceration with Extensive Urinary Extravasation, Immediate
of Complications, Prognosis.
Topics Discussed: injury to anterior urethra; straddle injury; trauma and thermal injuries; urethral contusion; urethral laceration; urologic injury.
"The anterior urethra is the portion distal to the urogenital
diaphragm. Straddle injury may cause laceration or contusion of
the urethra. Self-instrumentation or iatrogenic instrumentation
may cause partial disruption.Contusion of the urethra is a sign of crush injury without urethral
disruption. Perineal hematoma usually resolves without complications.There is usually a history of a fall, and in some cases a history
of instrumentation. Bleeding from the urethra is usually present.
There is local pain into the perineum and sometimes massive perineal
hematoma. If voiding has occurred and extravasation is noted, sudden
swelling in the area will be present. If diagnosis has been delayed,
sepsis and severe infection may be present.Major blood loss usually does not occur from straddle injury.
If heavy bleeding does occur, local pressure for control, followed
by resuscitation, is required.The patient with urethral contusion shows no evidence of extravasation,
and the urethra remains intact. After urethrography, the patient
is allowed to void;..."
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