Snapshot A 25-year old man presents to the emergency room after a motor vehicle accident. He reports severe pain in his groin. On physical exam, blood is noted at the tip of the penis. Pelvic radiograph reveals a fractured pelvis, and he is sent for a retrograde urethrogram. Introduction Clinical definition damage to the urethra Epidemiology Demographics more common in men urethra is shorter and more mobile (no attachments to the pubic bone) in women Etiology 80% of cases from blunt trauma straddle-type falls or direct blows anterior urethral injury pelvic fractures most often from motor vehicle accidents posterior urethral injury Physical or sexual assault Anatomy male urethra is divided into anterior (bulbous and pendulous) and posterior (prostatic and membranous) urethra Presentation Symptoms primary symptoms difficulty urinating urinary retention gross hematuria lower abdominal pain Physical exam blood at urethral meatus swelling or ecchymosis of penis, scrotum, or perineum rectal exam absent or abnormally positioned prostate (high riding prostate) Imaging Radiographs indications to evaluate for fractures recommend views pelvic Retrograde urethrogram indications must be done prior to insertion of transurethral bladder catheter Studies Urinalysis hematuria (gross or microhematuria) Diagnostic criteria retrograde urethrogram showing injury Treatment Non-operative transurethral bladder catheter and monitor for healing indications if injury is not too severe to necessitate surgery Operative surgical repair indications severe injury may require diverting urine from injury by placing a suprapubic catheter Complications Urinary stricture Erectile dysfunction incidence 50% of those with urethral injury secondary to pelvic fracture Prognosis Rarely life-threatening