A 12 old boy presents with blunt abdominal trauma and pelvic fracture. He has passed only few drops of blood per meatus and no urine in the past 8 hrs. On examination bladder is palpable. Which of the following is most likely cause?
|A||Anuria due to hemorrhagic shock|
|C||Ureteral rupture leading to extravasation of urine in retroperitoneum|
a. Symptoms of urethral injury include hematuria or inability to void. Physical examination may reveal blood at the meatus or a high-riding prostate gland upon rectal examination.
b. Extravasation of blood along the fascial planes of the perineum is another indication of injury to the urethra. "Pie in the sky" findings revealed by cystography usually indicate urethral disruption.
c. The diagnosis of urethral trauma is made by with retrograde urethrography, which must be performed prior to insertion of a urethral catheter to avoid further injury to the urethra.
d. The membranous urethra is prone to injury from pelvic fracture because the puboprostatic ligaments fix the apex of the prostate gland to the bony pelvis and thus cause shearing of the urethra when the pelvis is displaced.
e. The bulbar urethra is susceptible to blunt force injuries because of its path along the perineum.
f. Straddle-type injuries from falls or kicks to the perineal area can result in bulbar trauma.
g. The penile urethra is less likely to be injured from external violence because of its mobility, but iatrogenic injury from catheterization or manipulation can occur, which is also possible in the fossa navicularis