EpistemisUrethrorrhagia
Specialty: Nephrology and urology.
Why it occurs
- Urethral trauma (associated with pelvic fractures, straddle falls, or iatrogenesis due to forced or improperly removed bladder catheterization)
- Urethral stricture (with spontaneous rupture of small mucosal vessels due to excessive urinary effort)
- Urethral caruncle (benign and painful polypoid vascular lesion in the external urethral meatus, very common in postmenopausal women)
- Carcinoma of the urethra (uncommon primary neoplasm of the urethral mucosa)
- Severe erosive urethritis (severe urothelial inflammation with peeling and pinpoint bleeding)
Initial workup
Urgent retrograde urethrography (essential if urethral rupture or trauma is suspected to evaluate the integrity of the passage); flexible urethrocystoscopy (once traumatic rupture has been ruled out) to precisely locate the bleeding point; pelvic and transperineal ultrasound.
red flags
Copious and persistent urethrorrhagia with hemodynamic instability (hypotension, tachycardia), inability to void with acute urinary retention associated with intraurethral clots, or suspicion of traumatic urethral section (urethral meatus with blood after severe pelvic trauma, where blind catheterization of the bladder is contraindicated).
Standard management
- Tranexamic acid — 500 mg to 1 g every 8 hours orally or intravenously as a temporary antifibrinolytic, always evaluating previously that there are no thrombotic contraindications
- Phytomenadione — Vitamin K1, 10 mg slowly intravenous if associated with coagulopathy or overdose of oral anticoagulants
- Gentle perineal external compression or urinary diversion through suprapubic cystostomy by urology if there is suspicion of urethral section.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Nephrology and urology
- Listed causes
- 5
- Treatment options
- 3