Trauma: Urethra Trauma

Urethra Trauma

General

  • Associated with Pubic Rami Fractures
  • Anterior Injury: Bulbar & Penile
    • Most Common from Direct/Straddle Injury
  • Posterior Injury: Prostatic & Membranous
    • Most Common from Pelvic Fracture

AAST Urethra Injury Scale

Presentation

  • Blood at Urethral Meatus (98% Sensitivity)
  • High Riding Prostate
  • “Butterfly” Perineal Hematoma/Ecchymosis
  • Unable to Void
  • Unable to Pass Foley

Diagnosis

  • Retrograde Urethrogram (“RUG”)

Foley Catheterization

  • It May Be Appropriate to Allow a Single Attempt at Foley Catheterization
    • No Strong Evidence that a Single Attempt will Convert a Partial Tear into a Complete Disruption
  • Repeated Attempts at Foley Catheterization, However, Should Be Avoided
  • May Require Suprapubic Cystotomy if Unable to Place a Foley Catheter

Treatment

  • Anterior Injury:
    • Blunt:
      • Incomplete: Foley Catheter 2-3 Weeks
      • Complete: Suprapubic Cystostomy & Delayed Repair
    • Penetrating: Primary Repair with Foley Catheter
  • Posterior Injury: Suprapubic Cystostomy & Delayed Repair
    • If Small May Attempt Bridging Foley Catheter
    • Delay (3-6 Months) Allows Pelvic Hematoma to Resolve & Defect to Shorten; Preventing Early Stricture or Impotence
    • Indications for Immediate Repair (Never in Penetrating Injury):
      • Bladder Neck Injury
      • Rectal Injury

Urethra Anatomy 1

Urethra Injury: Partial (Left) & Complete (Right) 2

Butterfly Perineal Hematoma 3

References

  1. Gray H. Anatomy of the Human Body (1918). Public Domain.
  2. Seo IY, Lee JW, Park SC, Rim JS. Long-term outcome of primary endoscopic realignment for bulbous urethral injuries: risk factors of urethral stricture. Int Neurourol J. 2012 Dec;16(4):196-200. (License: CC BY-NC-3.0)
  3. Hajji F, Ameur A. Butterfly hematoma after traumatic intercourse. Pan Afr Med J. 2015 Apr 1;20:317. (License: CC BY-2.0)