If blood or bloody ooze is seen in the urethral opening, urethral injury is assumed. A tender, mobile, or high prostate on rectal exam also means urethral tear until proven otherwise. If a tear is suspected on clinical grounds, order a retrograde urethrogram. This study can be performed in seconds at the bedside, if other emergent problems do not take priority. A suprapubic cystostomy provides bladder drainage and allows monitoring of fluid output.
Further management is left to the urologist, as a lower-priority injury.
Back to Index. The bladder may rupture upward into the peritoneal cavity, or may rupture into the tissues between the pelvic wall and peritoneum. Rupture is usually caused by pelvic fracture. The ruptured bladder may present with blood in the urethral meatus. Lower abdominal or pubic area pain will usually be present.