Imaging abdomen trauma urethra trauma part 9 dr ahmed esawy blunt abdominal trauma penetrating abdominal trauma fast abdominal ultrasound haemoperitoneum pneumoperitoneum american association of surgeon in trauma AAST SUBCAPSULAR HAEMATOMA PARENCHYMAL LACERATION include different cases for oral radiodiagnosis examination all over the world CT /MRI Plain X ray images URETHRAL RUPTURE URETHRAL TEAR

2. An Article By
Dr. Ahmed Esawy
MBBS M.Sc MD

4. Causes:
usually caused by crushing force to the pelvis .
It is about 4-14 % of pts with pelvic fractures.
Clinical features :
- Blood at the external urethral meatus.
- High-riding prostate on DRE.
- Inability to pass a urethral catheter.
Complications :
- Strictures: (97%).
- Impotence: (19%).
- Urinary incontence: ( 4% ).
Urethral Injury

5. -Type I: posterior urethra stretched but intact
-Type II: urethra disrupted at the membranoprostatic junction
above the urogenital diaphragm
-Type III: membranous urethra disrupted, with extension to the
proximal bulbous urethra or disruption of the urogenital
diaphragm (most common type)
-Type IV: bladder neck injury with extension into the urethra
-Type IVa: injury of the base of the bladder and periurethral
extravasation simulating a true type IV urethral injury
-Type V: partial or complete pure anterior urethral injury
Urethral Injury

6. 1-Dynamic Retrograde urethrography (pericatheter
urethrogram).
2- MRI:
- Planning surgical approach for posterior
urethral disruption.
- Define damage to soft tissue adjacent to
urethral trauma.
3- U.S. :
- Define hematoma size and extension of
extravasation.
- Not used for primary diagnosis.

7. Type I :
1-Rupture of the puboprostatic
Ligament.
2-Cranial displacement of the
prostate.
3- Elongation of posterior urethra.
4- Elevated bladder.
5- No urethral rupture.
6- No CM Extravasation.
Retrograde urethrogram reveals
stretching of the posterior urethra

8.  Type II injury : Torn of
membranous urethra above an
intact urogenital diaphragm.
 RUG : CM. Extravasations
above cone shaped proximal
portion of the bulbous urethra.
contrast material extra vasation confined
to the area above the normal cone-shaped
proximal portion of the bulbous urethra

9.  Type III injury : Most common form of urethral injury.
The membranous urethra is disrupted with extension of injury into the proximal
bulbous urethra through the disruption of UGD.
RUG : CM. Extravasations at the membranous and bulbous urethra.
extravasations at the membranous and bulbous urethra

10. Type IV :
- Bladder neck injury with extension into the urethra.

11. TypeV : Injury of bulbous
urethra.
-Intact Buck’s fascia →
Dissection of urine, blood along penile shaft.
-Rupture Buck’s fascia →
Extravasation into prineum.

12. Posterior urethral rupture extending through the urogenital diaphragm to
involve the bulbous urethra following blunt trauma (type III urethral injury). Retrograde
urethrogram reveals contrast material extravasation at the membranous urethra (arrow).
The contrast material extends below the urogenital diaphragm and surrounds the
proximal bulbous urethra.

13. Bladder neck urethral injury (type IV) in a 23-year-old woman. (A) Cystogram
shows extraperitoneal contrast material extravasation (arrow) that extends from
the bladder neck to the left underneath the balloon of a Foley catheter. (B)
Cystogram obtained 2 minutes later shows progressive extraperitoneal contrast
material extravasation.

14. Retrograde Urethrogram:
Interpretation
Contrast extravasation + Contrast in bladder
Contrast extravasation only
PARTIAL Tear
COMPLETE Tear

15. Partial Tear

16. Complete Tear

17. Total urethral disruption

18. Anterior Urethra
More common than posterior
Direct trauma
Usually NO pelvic #
Blood at meatus
Unable to micturate
Penile/Scrotal/Perineal
Contusion
Hematoma
Fluid collection

19. CT Signs of Urethral Injury

20. Type I Injury
elevation of the prostatic apex above the
UGD.
Associated findings include distortion of the
prostatic contour and obscuration of the
preprostatic fat space by a hematoma

21. type II
injury
CT criteria specific for type II injury included
extravasation of urinary tract contrast material
that was confined above the UGD

22. Type III
injury
A-CT scan obtained through the perineal region
shows extravasated contrast material (arrows) in
the urinary tract below the UGD
(b) RUG image shows extravasated contrast
material (arrows) in the urinary tract at the level
of the UGD. a type III injury

23. Indicators of Urethral Injury That Are
Not Type Specific

24. Distortion or Obscuration of the
UGD Fat Plane
Distortion or obscuration of the UGD fat plane.
CT scan of a patient with a type II urethral injury shows partial absence
of the left UGD fat plane (arrow) with a normal right fat plane.

25. Hematoma of the
ischiocavernosus muscle
Hematoma of the
ischiocavernosus muscle.
(a) CT scan of a patient
with a type II urethral injury
shows a fracture of the left
ischiopubic ramus with a
hematoma of the
ischiocavernosus muscle
(arrowheads) and absence
of the adjacent fat plane.
(b) Contiguous section
obtained 10 mm above a
shows arterial
extravasation of contrast
material (h).

26. Distortion or Obscuration of the
Prostatic Contour
or obscuration of the prostatic contour. CT scan of a patient with a type I urethral injury
shows absence of the normal prostatic outline. A periprostatic hematoma obliterates
the fat planes. p = prostatic parenchyma.

27. Distortion or Obscuration of the
Bulbocavernosus Muscle
Distortion or obscuration of the bulbocavernosus muscle. (a) CT scan of a patient with a
type III urethral injury shows a distorted contour of the bulbocavernosus muscle
(arrowheads) with an obscured fat plane. Note the air in the urethra, which resulted
from an unsuccessful attempt at catheterization.

28. Hematoma of the Obturator
Internus Muscle
CT scan of a patient with a RUG-proved type II urethral
injury shows an extensive hematoma (h) of the
obturator internus muscle.

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