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Updated: Dec 2 2021

Urethral Injury

  • 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
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