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Urethral injury usually occurs in men. Most major urethral injury is due to blunt trauma. Penetrating urethral trauma is less common, occurring mainly from gunshot wounds, or, alternatively, from inserting objects into the urethra during sexual activity or because of psychiatric illness.
Urethral injuries are classified as contusions, partial disruptions, or complete disruptions, and they may involve the posterior or anterior urethral segments. Posterior urethral injuries occur almost exclusively with pelvic fractures. Anterior urethral injuries are often consequences of a perineal straddle injury. from a fall, perineal blow, or motor vehicle crash.
Complications include stricture formation, infection, erectile dysfunction, and incontinence.
Symptoms and Signs
Symptoms include pain with voiding and inability to void. Blood at the urethral meatus is the most important sign of a urethral injury. Additional signs include perineal, scrotal, and penile ecchymosis, edema, or both, and a high-riding prostate on rectal examination.
Diagnosis
In any patient with suggestive symptoms or signs, the diagnosis is confirmed by retrograde urethrography, which should be done before catheterization. Urethral catheterization in a patient with an undetected significant urethral injury may potentiate urethral disruption (eg, convert a partial disruption to a complete disruption).
Treatment
Contusions can be safely treated with an indwelling transurethral catheter for 10 days. Partial disruptions are best treated with bladder drainage via suprapubic cystostomy. In selected cases of posterior partial disruptions, primary urethral realignment using catheterization may be attempted; if successful, this approach limits subsequent urethral strictures.
Complete disruptions are treated with bladder drainage via suprapubic cystostomy. This option is simplest and can be used safely in all patients. Definitive surgery is deferred for about 8 to 12 wk until the urethral scar tissue has stabilized and the patient has recovered from any accompanying injuries.
Selected penetrating urethral injuries and blunt urethral injuries that occur with penile fractures may be sutured primarily.
Last full review/revision February 2007 by Noel A. Armenakas, MD
Content last modified February 2012
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