The external urethral meatus should be specifically examined in the patient with pelvic injury. Blood at the meatus is a marker of urethral disruption. An ascending urethrogram is the investigation of choice. A foley catheter is inserted so the balloon is just inside the urethra. The balloon is gently inflated with 5mls or so of contrast - only enough to achieve a seal. Contrast is injected, ideally under fluoroscopic control. Plain films may be substituted if fluoroscopy is not available
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This urethrogram shows complete transection of the urethra with leak of contrast into the surrounding tissues. |
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Supra-pubic catheters should be placed only when necessary, especially in the presence of pelvic injury. Suprapubic catheters may interfere with subsequent pelvic reconstructive surgery due to their position or risk of infection of metalwork. However, patients with urtheral injuries such as these will require suprapubic catheters prior to further investigation of management of the urethral injury.