Case Study - June 2014
This 26 year old gentleman was involved in a road traffic accident which caused an open pelvic fracture. In A&E, he had blood at the external urethral meatus.
1. What test is this?
2. What does it show?
3. What management options are there?
4. What are the long term consequences?
Reveal Answer
1. This is a urethrogram. This can be performed in resus using a C-arm image intensifier. A small 12F catheter is placed at the external meatus and 5mls of water is placed in the catheter retention balloon. Gentle traction is applied to pull the penis straight and contrast is injected whilst screening to outline the urethral anatomy.
2. This urethrogram shows a pelvic-fracture urethral distraction defect.
3. Available emergency treatment options are dependend on skill-mix and equipment available. Options include placement of a suprapubic catheter, and if contrast is seen to enter the bladder, it would be reasonable to undertake gentle expert placement of a urethral catheter, which could be aided by a cystoscopically or radiologically placed guidewire.
4. Most men will develop a proximal urethral stricture which will require a proximal urethroplasty to treat. Risks with this surgery include recurrent stricture, incontinence and impotence. Interestingly in this case, the patient was catheterised acutely using a flexible cystscopy. Three months after the injury, despite a stricture evident on a urethrogram, the pateint has minimal symptoms and is being managed expectantly. He has no erections.