MEATAL BLOOD Blood at the meatus is associated with urethral injuries. Urethral injuries are almost exclusively seen in males. Posterior urethral injuries are commonly associated with pelvic fractures. A superiorly displaced prostate indicates disruption of the posterior urethra. Anterior urethral injuries are associated with straddle injuries and instrumentation.
When meatal blood is noted, a urinary catheter should not be placed in order to prevent the conversion of a partial urethral laceration into a complete transection. A retrograde urethrogram is virtually mandatory in this setting.
HEMATURIA For the purposes of trauma, microscopic hematuria is defined as more than five red blood cells (RBCs) per high-power field (hpf). A 10-mL specimen must be centrifuged for 5 min at 2000 revolutions for an accurate assessment. Gross hematuria is, of course, readily visible blood. Reddish urine does not necessarily indicate hematuria; several medications and toxic substances may cause discoloration ( T§bl®..254.:3). Also, results of a dipstick evaluation may be erroneous, since myoglobin, a frequent finding in major trauma, reacts with the reagent.
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