What is Urethral Trauma?

Injury to the urethra doesn’t happen very often. But this can result from straddle-type falls or pelvic fractures. Dealing with these problems quickly and properly is critical for the best results.

Male Urinary Tract
Male urinary tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

Female Urinary Tract
Female urinary tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

What Happens under Normal Conditions?

The urethra is a tube-like organ that carries urine from the bladder out of the body. In males, the urethra starts at the bladder and runs through the prostate gland, perineum (the space between the scrotum and the anus), and through the penis. The anterior ("front") urethra goes from the tip of the penis through the perineum. The posterior ("back") urethra is the part deep within the body.

In females, the urethra is much shorter: it runs from the bladder to just in front of the vagina. It opens outside the body. Normal urine flow is painless and can be controlled. The stream is strong and the urine is clear with no visible blood.

What is Urethral Trauma?

Urethral trauma is when the urethra is hurt by force.

Trauma to the anterior urethra is often from straddle injuries. This can occur with a sharp blow to the perineum. This type of trauma can lead to scars in the urethra ("urethral stricture"). These scars can slow or block the flow of urine from the penis.

Trauma to the posterior urethra almost always results from a severe injury. In males, posterior urethral trauma may tear the urethra completely away below the prostate. These wounds can form scar tissue that slows or blocks the urine flow.

For females, urethral injuries are rare. They're always linked to pelvic fractures or cuts, tears, or direct trauma to the body near the vagina.

Urethral injury can also result from objects piercing the sex organs or pelvis.



What are the Symptoms of Urethral Trauma?

Trauma to the urethra can allow urine to leak into the tissues around it. This can cause:

  • Swelling
  • Inflammation
  • Infection
  • Pain in the belly

Other signs of urethral trauma are:

  • Not being able to pass urine
  • Urine building up in the bladder
  • Blood in the urine ("hematuria")

For males, the most common sign of a problem is blood – even a drop – at the tip of the penis. Swelling and bruising of the penis, scrotum, and perineum may also occur, along with pain in that area.



What Causes Urethral Trauma?

Trauma to the anterior urethra can be caused by straddle injuries—coming down hard on something between your legs, such as a bicycle seat or crossbar, a fence, or playground equipment.

Trauma to the posterior urethra can be caused by pelvic fractures from:

  • Car crashes
  • Crush injuries
  • Falls from very high heights
  • Bullets or knives

For females, urethral injuries can also be caused by sexual assault.



How is Urethral Trauma Diagnosed?

If you have blood at the end of the penis or in the urine or can’t pass urine after an injury to the urethral area, you should see a health care provider right away.

Your health care provider may try to pass a tube ("catheter") through your urethra. Not being able to pass a tube into the urethra is the first sign of urethral injury. An x-ray is done after squirting a special dye into the urethra. The dye is used to be seen on an x-ray. X-rays are taken to see if any of the dye leaks out of the urethra inside your body. This would mean there’s an injury. An x-ray of the urethra is often done after a pelvic fracture, because urethral injury is common in these cases (about 1 in 10 cases).



How is Urethral Trauma Treated?

The treatment for urethral trauma depends on where and how bad the injury is. Many cases of anterior urethral injury need to be fixed right away with surgery.

Minor of these injuries can be treated with a catheter through the urethra into the bladder. This keeps urine from touching the urethra so it can mend. The catheter is often left in place for 14 to 21 days. After that time, an x-ray is taken to see if the injury has healed. If it has healed, the catheter can be taken out in the doctor's office. If the x-ray still shows leaks, the catheter is left in longer.

If serious urethral trauma is seen on the x-ray, a tube is used to carry urine away from the injured area to keep it from leaking. Urine leaking inside the body can cause:

  • Swelling
  • Inflammation
  • Infection
  • Scarring

The treatment of a posterior urethral injury is very complicated. This is because it's almost always seen with other severe injuries. Unfortunately, it means that this problem can't be fixed right away. Most urologists first place a catheter in the bladder at the time of injury and wait for 3 to 6 months. This gives the body time to reabsorb the bleeding from the pelvic fracture. It's also easier to fix the urethra after swelling in the tissues from a pelvic injury has gone down. Most posterior urethral injuries need an operation to connect the 2 torn edges of the urethra. This is most often done through a cut in the perineum.

If the urethra has completely torn away, urine must be drained. This is done with a tube stuck into the bladder through the skin ("suprapubic"). This Foley catheter goes through the skin just above the pubic bone in the lower belly into the bladder. This is most common after severe injuries. The tube can be put in at the time of abdominal surgery for other repairs. Or it can be done through a small puncture. An x-ray can be used to see that the catheter is in the bladder. Your doctor may suggest a procedure to rejoin the torn urethra over a catheter, which may help it heal.



What Can I Expect after Treatment for Urethral Trauma?

If surgery was done, the catheter left in the bladder can be uncomfortable. Also, the catheter can bother the bladder and cause it to contract on its own, which can hurt. This can also cause some blood to be seen in the urine. These symptoms often clear up after the catheter is taken out.

The most common problem after urethral repair is scarring in the urethra. The scars can partly block the urine flow, causing the stream to be weak. You may also have to strain to urinate. Your urologist can often fix this by widening the scarred section. This is done with instruments placed through the urethra. Sometimes the surgery needs to be done again to keep the urethra open.

If you had a pelvic fracture urethral injury, your urologist will arrange follow-up visits. These are to make sure you don’t develop erectile dysfunction, or urine control problems.



Frequently Asked Questions

Will I need further surgery after my operation for a posterior urethral injury?

Most patients don’t need further surgery or expansion of urethral scarring after repair.

Will the injury or the surgery cause problems with sex?

Surgery to fix the urethra rarely causes erectile dysfunction. But severe posterior injuries can also harm the delicate nerves that run beside the urethra deep within the body. These nerves send the signal to the penis to become erect for sex. About 5 out of 10 men who have urethral injuries from pelvic fractures will have some type of erectile dysfunction once they heal. This may range from very mild to full erectile dysfunction. But there are many ways to treat this.

Will the injury or the surgery cause me to leak urine?

A small number of patients (2 to 5 out of 100) have problems with incontinence after having posterior urethral trauma fixed. This is thought to be caused by damage to the nerves that control the bladder outlet. This damage is a result of the injury and not from the surgery.