You are examining a 27 year old male who presents to the ED after slipping off a ledge in an elevator shaft. He was just hired on as an elevator technician and received only 1 day of formal training. He works for the silicon valley startup called “Going Up”, where they crowdsource technicians with an app. The patient slipped and fell several feet down the shaft, eventually straddling a crossbeam. He felt immediate pain and has not been able to urinate since the accident. Which of the following is true?

A. If a foley is inserted and draining urine in the setting of pelvic fracture, the foley should still be removed

B. The majority of urethral injuries are nonoperative

C. Anterior urethral injuries are commonly complicated by incontinence

D. Performing a retrograde urethrograde is always indicated in the setting of suspected urethral trauma

E. Posterior urethral injuries are most commonly secondary to pelvic fractures

References:

Gomez RG, Ceballos L, Coburn M, et al. Consensus statement on bladder injuries. BJU Int 2004; 94:27.

Haas CA, Brown SL, Spirnak JP. Limitations of routine spiral computerized tomography in the evaluation of bladder trauma. J Urol 1999; 162:51.

Hsieh CH, Chen RJ, Fang JF, et al. Diagnosis and management of bladder injury by trauma surgeons. Am J Surg 2002; 184:143.

Sklar DP, Diven B, Jones J. Incidence and magnitude of catheter-induced hematuria. Am J Emerg Med 1986;4:14–16. PMID: 3947427

Vaccaro JP, Brody JM. CT cystography in the evaluation of major bladder trauma. Radiographics 2000; 20:1373.


Blake Briggs