Q: What are the four segments of the male urethra (from anterior to posterior)? show answer
Q: Which is more common as a result of pelvic fracture: bulbomembranous junction injury or prostatomembranous junction injury? show answer
Unfortunate shotgun wound, leading to a number of pelvic difficulties, including urethral transection at initial trauma evaluation. Suprapubic tube placed. Re-evaluation.
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On the scout radiographs, the patient has a number of small metallic bodies in the pelvis, compatible with the history of a gunshot wound.
On the RUG, there is a leak at the level of the bulbar urethra and a beak-like cessation of contrast far below the external sphincter.
On the VCUG, contrast is administered via the patient's indwelling suprapubic catheter. The posterior urethra opens normally, but there is a leak at the level of the bulbar urethra and evidence of a transection just upstream from the penoscrotal junction. The radio-opaque disc is an internal control for measurement (known diameter of 13 mm).
On the post image, there is a small amount of contrast in the left side of the perineum and scrotal tissue.
Urethral transection is a complication of injuries to the pelvis, including pelvic fractures, straddle injuries, or, in this case, a shotgun wound.
If this patient had shown up in the emergency department, it is clear that trying to immediately place a Foley catheter before attempting a RUG would have had the disasterous consequence of creating a false channel with the catheter and causing even more damage that was already there.
The most common site of traumatic injury of the posterior urethra is at the bulbomembranous junction, where a shear force can occur in a pelvic fracture between the more mobile bulbar urethra and the more rigid membranous urethra. In the case of a gunshot wound, however... the injury can be anywhere.
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