A 35-year-old engineer presented with bleeding from external meatus and perineal hematoma, after he fell astride on a scaffolding, half-an-hour back. The patient had not passed urine since the accident. On physical examination there was no evidence of extravasation of urine and the bladder was not distended. What would be the immediate management?
Correct Answer: Assess the urethral injury by ascending urethrography
Description: Assess the urethral injury by ascending ......... The bulbous urethra may be injured as a result falling astride an object. Urethral contusion may cause a perineal hematoma without urethral disruption. Perineal hematoma usually resolves without complications. Laceration will lead to urinary extravasation. The patient usually has a desire to void, but voiding should not be allowed until assessment of the urethra is complete. No attempt should be made to pass a urethral catheter, but if the patient's bladder is over distended, percutaneous suprapubic cystostomy can be done as a temporary procedure. A urethrogram with instillation of 15 - 20 m1 of contrast material, will demonstrate extravasation and the location of injury. The contused urethra will show no evidence of extravasation. If there is no evidence of extravasation on the urethrogram, a urethral catheter may be passed into the bladder. Extravasation is a contraindication to fuher instrumentation at this time. After the urethrography, the patient with urethral contusion is allowed to void; and if the voiding occurs normally, without pain or bleeding no additional treatment is necessary. If bleeding persists urethral catheter drainage can be done. If urethral laceration is detected on urethrography instrumentation of the urethra should be avoided. A suprapubic cystostomy tube should be inseed (through a small incision in the suprapubic area to expose the dome of the bladder) to allow complete urinary diversion while the urethral laceration heals.
Category:
Surgery
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