Traumatic urethral injuries: Does the digital rectal examination really help us?

Ball, Chad G.; Jafri, Syed-Mohammed; Kirkpatrick, Andrew W.; Rajani, Ravi R.; Rozycki, Grace S.; Feliciano, David V.; Wyrzykowski, Amy D.

doi:10.1016/j.injury.2009.03.003

Cited by 32 publications

(13 citation statements)

References 11 publications

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“…The two classic signs of PFUI are blood at the urethral meatus and a superiorly displaced prostate that is movable during a digital rectal examination . Blood at the meatus is the common sign of urethral injury, but it cannot be ruled out even if it is absent and the degree of bleeding does not correlate with the severity of the injury . A rectal examination should always be carried out to exclude an accompanied rectal injury, which is noticed by blood on the examination finger and/or a palpable rectal laceration .…”

Section: Presentation and Assessment Of Pfuismentioning

confidence: 99%

“…A rectal examination should always be carried out to exclude an accompanied rectal injury, which is noticed by blood on the examination finger and/or a palpable rectal laceration . A rectal examination might show a superiorly displaced (“high‐riding”) prostate, which is relatively unreliable in the acute setting of PFUI, because the pelvic hematoma caused by pelvic fractures often disturb precise palpation of a small prostate, particularly in young males . Other signs of urethral injury include difficulty or inability to pass a urethral catheter and a distended palpable bladder due to the inability to void .…”

Section: Presentation and Assessment Of Pfuismentioning

confidence: 99%

“…2,[24][25][26] Blood at the meatus is the common sign of urethral injury, but it cannot be ruled out even if it is absent and the degree of bleeding does not correlate with the severity of the injury. 24,25,27 A rectal examination should always be carried out to exclude an accompanied rectal injury, which is noticed by blood on the examination finger and/or a palpable rectal laceration. 2,16,28 A rectal examination might show a superiorly displaced ("high-riding") prostate, which is relatively unreliable in the acute setting of PFUI, because the pelvic hematoma caused by pelvic fractures often disturb precise palpation of a small prostate, particularly in young males.…”

Section: Presentation and Assessment Of Pfuismentioning

confidence: 99%

“…2,16,28 A rectal examination might show a superiorly displaced ("high-riding") prostate, which is relatively unreliable in the acute setting of PFUI, because the pelvic hematoma caused by pelvic fractures often disturb precise palpation of a small prostate, particularly in young males. 27,29,30 Other signs of urethral injury include difficulty or inability to pass a urethral catheter and a distended palpable bladder due to the inability to void. 2,31 It should be also noted that the clinical symptoms might become apparent only >1 h after the injury.…”

Section: Presentation and Assessment Of Pfuismentioning

confidence: 99%

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Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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Pelvic fractures from high‐energy blunt force trauma can cause injury to the posterior urethra, known as pelvic fracture urethral injury, which is most commonly associated with unstable pelvic fractures. Pelvic fracture urethral injury should be suspected if a patient with pelvic trauma has blood at the meatus and/or difficulty voiding, and retrograde urethrography should be carried out if the patient is stable. Once urethral injury is confirmed, urinary drainage should be established promptly by placement of a suprapubic tube or primary realignment of the urethra over a urethral catheter. Although pelvic fracture urethral injury is accompanied by subsequent urethral stenosis in a high rate and it has been believed that primary realignment can reduce the risk of developing urethra stenosis, it also has a risk of complicating stenosis and its clinical significance remains controversial. Once inflammation and fibrosis have stabilized (generally at least 3 months after the trauma), the optimal management for the resulting urethral stenosis is delayed urethroplasty. Delayed urethroplasty can be carried out via a perineal approach using four ancillary techniques in steps (bulbar urethral mobilization, corporal separation, inferior pubectomy and urethral rerouting). Although pelvic trauma can impair continence mechanisms, the continence after repair of pelvic fracture urethral injury is reportedly adequate. Because erectile dysfunction is frequently encountered after pelvic fracture urethral injury and most patients are young with a significant life expectancy, its appropriate management can greatly improve quality of life. In the present article, the key factors in the management of pelvic fracture urethral injury are reviewed and current topics are summarized.

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Section: Presentation and Assessment Of Pfuismentioning

confidence: 99%

Section: Presentation and Assessment Of Pfuismentioning

confidence: 99%

Section: Presentation and Assessment Of Pfuismentioning

confidence: 99%

Section: Presentation and Assessment Of Pfuismentioning

confidence: 99%

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Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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“…A recent review on open pelvic fractures by Grotz et al [109] resulted in similar recommendations regarding diagnosis of anorectal injuries associated. Some authors questioned the use of routine performance of PR examination in the secondary survey of the trauma victim in both adults [110,111] and children [112] resulting in the recent change of the ATLS guidelines [16]. However nobody questions its value and indication in case of pelvic fractures.…”

Section: Discussionmentioning

confidence: 99%