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Urethral Injuries

By Noel A. Armenakas, MD, Clinical Professor of Urology;Attending Surgeon, Weill Cornell Medical School;New York Presbyterian Hospital and Lenox Hill Hospital

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The urethra is the tube that carries urine from the bladder outside the body. In men, the urethra runs through the middle of the penis.

Most urethral injuries occur in men. Common causes include pelvic fractures and straddle injuries to the perineum. The perineum is the area between the anus and the scrotum (or in women between the anus and vulva).

The urethra can also be injured unintentionally during surgical procedures done directly on the urethra or during procedures in which instruments are passed into the urethra, such as bladder catheterization or cystoscopy (passing a flexible viewing tube through the urethra into the bladder). Occasionally, injuries result from gunshot wounds. Rarely, urethral injuries can be self-inflicted when a person inserts a foreign object directly into the urethra, or they can occur with a penile fracture.

Some injuries to the urethra are limited to bruising. Injury to the urethra can also tear the lining, resulting in leakage of urine into the tissues of the penis, scrotum, abdominal wall, or perineum.

Complications that can result from urethral injuries include infection, bleeding, permanent narrowing (stricture), erectile dysfunction, and uncontrollable loss of urine (urinary incontinence).

Symptoms

The most common symptoms include blood at the tip of the penis in men or the urethral opening in women, blood in the urine, an inability to urinate, and pain during urination. Bruising may be visible between the legs or in the genitals. Other symptoms may arise when complications develop. For example, if urine leaks into surrounding tissues, infection may result. In addition, the injury may cause the urethra to narrow (stricture) near or at the site of injury. Men may also experience impairment in the ability to have an erection (erectile dysfunction), caused by damage to the nerves or blood supply to the penis.

Diagnosis

  • Retrograde urography

In men, the diagnosis of a urethral injury is usually confirmed by retrograde urethrography, an x-ray taken after a radiopaque contrast agent, a liquid that is visible on x-rays, is put directly into the end of the urethra. Retrograde urethrography is done before a catheter is passed through the urethra into the bladder. In women, a flexible endoscope is used to examine the lining of the bladder and the urethra (cystoscopy).

Treatment

  • Bladder drainage tube

  • Sometimes surgery (to repair urethral tears)

For urethral bruises that do not result in any leakage of urine, a doctor can place a catheter through the urethra into the bladder for several days to drain the urine while the urethra heals.

For urethral tears, the urine should be diverted from the urethra using a catheter placed directly into the bladder through the skin over the lower abdomen. The urethra is repaired surgically after all other injuries have healed or after 8 to 12 weeks (when inflammation has resolved). Rarely, urethral tears heal without surgery.

Treatment helps to prevent some complications of urethral injuries. Complications that cannot be prevented are treated accordingly.