ABSTRACT
Manage Assess airway, breathing, circulation as for all trauma patientsnote: Some experts state that repairing life-threatening hemoperitoneum and brainstem herniation takes precedence over aortic rupture. Pelvic fractures cause most proximal urethral injuries, whereas falls or straddle injuries usually cause anterior urethral injuries. Perform abdominal, perineal, and rectal examination, and obtain a urethrogram if injury is suspected. Blunt abdominal or perineal trauma with gross hematuria, blood at the urethral meatus, pelvic fracture, abnormal retrograde urethrogram, or inability to void or little or no urine from Foley catheter. Intraperitoneal rupture releases dye into the abdomen; exploration of the abdomen plus repair are often required. Extraperitoneal rupture releases dye into perivesical tissues, whereas washout may show dye behind the bladder.
