Urethral injury
Updates to Article Attributes
Urethral injuries can result in long-term morbidity and most commonly result from trauma. The male urethra is much more commonly injured than the female urethra and is the focus of this article.
Clinical presentation
In the setting of trauma, blood of the external urethral meatus or vaginal introitus may be seen but is an unreliable sign.
Pathology
Male urethral injuries are divided into anterior (penile/bulbar) and posterior (membranous/prostatic) urethral injuries. Injuries, of course, may be partial or complete. There are a variety of causes:
- blunt trauma: due to shearing or straddle injuries
- associated with pelvic fractures (occurs in
~ 10~10%) - often associated with bladder injury
- associated with pelvic fractures (occurs in
- penetrating trauma: e.g. stab wounds, gunshot wounds, dog bites (more commonly affect the anterior urethra)
- iatrogenic, for example
:- urethral instrumentation, e.g. catheterisation, Foley catheter removal without balloon deflation, cystoscopy
- post-surgical (e.g. surgery for benign prostatic hyperplasia)
Classification
See: Goldman classification of urethral injuries
Radiographic features
Fluoroscopy
Retrograde urethrography is the modality of choice. It will demonstrate extraluminal contrast, which has extravasated from the urethra.
CT
CT cystography can be performed but this is much less specific for urethral vs. bladder injury. Other features of urethral injury include retropubic and perivesical haematoma and obscuration of the urogenital fat plane.
Treatment and prognosis
Treatment consists from urinary diversion (e.g. suprapubic catheter) to primary or delayed urethral anastomosis depending on the severity (i.e. tear vs. complete rupture) of the injury. Urethral stricture is the most common long-term complication.
-<li>associated with <a title="Pelvic fractures" href="/articles/pelvic-fractures">pelvic fractures</a> (occurs in ~ 10%)</li>-<li>often associated with <a title="Bladder rupture" href="/articles/urinary-bladder-rupture">bladder injury</a>- +<li>associated with <a href="/articles/pelvic-fractures">pelvic fractures</a> (occurs in ~10%)</li>
- +<li>often associated with <a href="/articles/urinary-bladder-rupture">bladder injury</a>
-<li>iatrogenic, for example:<ul>- +<li>iatrogenic, for example<ul>
-<li>post-surgical (e.g. surgery for <a title="BPH" href="/articles/benign-prostatic-hypertrophy">benign prostatic hyperplasia</a>)</li>- +<li>post-surgical (e.g. surgery for <a href="/articles/benign-prostatic-hypertrophy">benign prostatic hyperplasia</a>)</li>
-</ul><h4>Radiographic features</h4><h5>Fluoroscopy</h5><p><a href="/articles/urethrography">Retrograde urethrography</a> is the modality of choice. It will demonstrate extraluminal contrast, which has extravasated from the urethra. </p><h5>CT</h5><p>CT cystography can be performed but this is much less specific for urethral vs. bladder injury. Other features of urethral injury include retropubic and perivesical haematoma and obscuration of the urogenital fat plane. </p><h4>Treatment and prognosis</h4><p>Treatment consists from urinary diversion (e.g. <a title="suprapubic catheter" href="/articles/suprapubic-catheter">suprapubic catheter</a>) to primary or delayed urethral anastomosis depending on the severity (i.e. tear vs. complete rupture) of the injury. <a href="/articles/urethral-stricture">Urethral stricture</a> is the most common long-term complication. </p>- +</ul><h5>Classification</h5><p>See: <a title="Goldman classification of urethral injuries" href="/articles/goldman-classification-of-urethral-injuries">Goldman classification of urethral injuries</a></p><h4>Radiographic features</h4><h5>Fluoroscopy</h5><p><a href="/articles/urethrography">Retrograde urethrography</a> is the modality of choice. It will demonstrate extraluminal contrast, which has extravasated from the urethra. </p><h5>CT</h5><p>CT cystography can be performed but this is much less specific for urethral vs. bladder injury. Other features of urethral injury include retropubic and perivesical haematoma and obscuration of the urogenital fat plane. </p><h4>Treatment and prognosis</h4><p>Treatment consists from urinary diversion (e.g. <a href="/articles/suprapubic-catheter">suprapubic catheter</a>) to primary or delayed urethral anastomosis depending on the severity (i.e. tear vs. complete rupture) of the injury. <a href="/articles/urethral-stricture">Urethral stricture</a> is the most common long-term complication. </p>