Male hipster presents – bicyclist struck. He is 22 years old, lives in Williamsburg, and arrives wearing really tight pants and an ironic mustache. He reports pelvic pain and reports he fell off the seat onto his handlebars. He reports feeling “devo” about how “totes hard” he hit his groin (see link here for translation, though these are probably already outdatedly unhip).
Take a guess at the diagnosis.
Urethral Injury
Name 5 physical exam findings?
Blood at the external urethral meatus, high riding prostate, “butterfly” perineal hematoma, scrotal hematoma, gross hematuria
What do you probably not want to do?
Put in a Foley.
Why?
You can accidentally insert the foley into the tear making…everything worse.
What if you already put it in?
LEAVE IT IN! As long as urine is coming out/it’s working.
What would you find on physical exam if the patient was a woman with the same injury?
Vaginal Bleeding
Diagnose by?
Retrograde urethrogram – “gently” put 20-30 ml of contrast in the urethra and shoot an X-Ray
Treatment?
After evaluating for life-threatening injuries, Tininalli’s recommends: supra-pubic cath with urgent (not emergent) surgical repair. Per “Trauma, 11th ed”, GU can put a fiberoptically placed foley, or attempt “gentle” foley placement. DON’T put the foley in yourself
By Dr. Andrew Grock and Dr. Sally Bogoch
Reference
Tintinalli’s 7th ed
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