Editing Lower Urinary Tract Trauma (section)

==== <span style="color:#ff0000">Imaging</span> ====
* '''<span style="color:#ff0000">Modality: retrograde urethrogram (RUG)</span>'''
** See [https://radiopaedia.org/cases/traumatic-urethral-injury-on-retrograde-urethrogram figure] of retrograde urethrogram of traumatic proximal urethral injury
** '''<span style="color:#ff0000">Should be performed immediately when urethral injury is suspected</span>'''
*** '''May demonstrate partial or complete urethral disruption, providing guidance for how to best manage bladder drainage in the acute setting'''
***'''<span style="color:#ff0000">Blind catheter passage prior to RUG should be avoided, unless exceptional circumstances indicate an attempt at emergent catheter drainage for monitoring</span>'''
**** Patients with pelvic fracture urethral injury (PFUI) are often unable to urinate due to their injuries. Trauma resuscitations typically involve aggressive hydration and a critical need to closely monitor patient volume status
**** In the acute setting of a partial urethral disruption, a single attempt with a well-lubricated catheter may be attempted by an experienced team member.
** '''<span style="color:#ff0000">Technique</span>'''
**# '''<span style="color:#ff0000">Position the patient obliquely with the bottom leg flexed at the knee and the top leg kept straight</span>'''
**#* If severe pelvic or spine fractures are present, leaving the patient supine and placing the penis on stretch to acquire the image is appropriate.
**# '''Introduce a catheter tipped syringe or a 12Fr Foley catheter into the fossa navicularis'''
**# '''Place the penis on gentle traction'''
**# '''Inject 20-25 mL undiluted water-soluble contrast material and capture images'''
** '''<span style="color:#ff0000">Occasionally a Foley catheter has been placed before evaluating the urethra</span>'''
*** '''<span style="color:#ff0000">If no meatal blood is present and suspicion of injury is low, further imaging is not warranted.</span>'''
*** '''<span style="color:#ff0000">If blood is present, a pericatheter RUG should be performed to identify potential missed urethral injury.</span>'''
**** A pericatheter RUG can be done by injecting contrast material through a 3Fr catheter or angiocatheter held in the fossa navicularis to distend the urethra and prevent contrast leak per meatus.