Penis Injury and Hematuria in a Man Who Fell on a Log

D. Brady Pregerson, MD


March 19, 2021

Physical Examination and Workup

Upon physical examination, the vital signs are normal, with a heart rate of 80 beats/min and a blood pressure of 132/76 mm Hg. The patient is afebrile and appears to be in no acute distress. The initial examination of the genitourinary and perineal region reveals blood at the urethral meatus (Figure 1).

Figure 1.

A paper towel that the patient has been using to keep his underwear clean is soaked with a moderate amount of blood. No external lacerations, abrasions, or ecchymoses are identified at the urethral meatus, on the remainder of the penis, or in the perineum. Inspection of the scrotum and palpation of the testicles are unremarkable. The abdomen is not tender upon palpation, and no flank or costovertebral area tenderness is noted. The remainder of the physical examination, including examination of the heart, lungs, and musculoskeletal system, is unremarkable for any abnormalities or evidence of additional trauma.

A urine sample at the bedside is noted to be the color of red wine, and a formal urine analysis confirms the presence of gross hematuria. A complete blood cell count is ordered, and the results are unremarkable, with a normal white blood cell count and a hematocrit of 45% (0.45). A coagulation profile is conducted, also with unremarkable results. A series of plain radiographs of the pelvis are performed, and the results are normal, with no obvious evidence of fracture. A retrograde urethrogram (RUG) is subsequently obtained (Figure 2).

Figure 2.


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