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Urethral Trauma

Fortunately urethral injuries are uncommon. But injuries can occur as a result of straddle- type falls or pelvic fractures. The following information should help explain why timely evaluation and proper management of these injuries are critical for the best outcomes.

What happens under normal conditions?

The urethra is a the tube through which urine (and in males, semen) leaves the body. In males, the urethra begins at the bladder and then extends through the prostate gland, perineum and the entire length of the penis. The anterior urethra goes from the tip of the penis through the perineum, the space between the scrotum and the anus. The posterior urethra is deep within the body. In females, the urethra is much shorter and extends from the bladder to just in front of the vagina outside the body. Normally, urine flow can be controlled, the stream is strong, the urine is clear and there is never any visible blood in the urine.

What is urethral trauma?

Urethral trauma can affect two different parts of the urethra. Trauma to the anterior urethra is usually the result of straddle-like injuries. This trauma occurs when a person sustains injury from a sharp blow to the perineum since the urethra is located near the skin in this area. This injury can occur, for example, when a child forcefully straddles a bicycle seat or bar or a fence. Trauma to the anterior urethra can lead to scarring called a urethral stricture, scarring that can slow or block the flow of urine from the penis.

Trauma to the posterior urethra is almost always occurs as a result of severe injuries such as pelvic fractures following automobile accidents or falls from significant heights. In males, posterior urethral trauma may result in the urethra being completely torn just below the prostate. These severe injuries can also lead to scar tissue that slows or blocks the normal flow of urine. For females, urethral injuries are rare and almost always related to pelvic fractures or cuts, tears, or direct trauma to the vaginal area.

What are the symptoms of urethral trauma?

Trauma to the urethra can cause significant problems. Injury can cause leakage of urine into surrounding tissues and result in swelling, inflammation, infection and abdominal pain. Urethral trauma can also cause the inability to urinate, retention of urine in the bladder and 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 the affected area.

How is urethral trauma diagnosed?

Individuals who have blood at the end of the penis or in the urine or who cannot urinate following an injury to the urethral area should see a physician immediately so that an appropriate evaluation (including X-rays) can be performed.

In any patient who suffers a pelvic fracture, an X-ray of the urethra is routinely performed because of the high incidence of urethral injury (about 10 percent) associated with such injuries. This X-ray is performed by injecting x-ray contrast dye into the opening of the urethra. X-rays are taken to see if any of the dye leaks out of the urethra, which indicates an injury.

How is urethral trauma treated?

The treatment options for urethral trauma depend on the severity and location of the injury. Some partial urethral injuries can be treated with the insertion of a catheter, which is usually left in place for 14 to 21 days to allow the urethra to mend, and then an X-ray is performed to confirm that the injury has healed.

In the case of an anterior urethral injury, the injury may need to be repaired immediately with surgery. Minor injuries may be treated by diverting the urine away from the injury with a special tube inserted into the bladder (called a Foley catheter). Later, an X-ray of the urethra is repeated after the catheter has been in place for two to three weeks. If the injury has healed, the catheter can be removed in the doctor's office.

In general, if serious urethral trauma is seen on the X-ray, urine should be diverted away from the injured area to prevent leakage of urine and subsequent swelling, inflammation, infection and scarring. In the case of complete urethral tearing, urine must be drained from the bladder by placing a suprapubic catheter. This is a Foley catheter that goes directly through the skin just above the pubic bone in the lower abdomen into the bladder.. This is most common after severe posterior urethral injuries. This can be done at the time of abdominal surgery for other associated injuries or through a small puncture wound with the aid of X-ray to be sure that the catheter is placed in the bladder. The doctor may also discuss a procedure to “realign” the torn urethra over a catheter, which may allow better healing.

The treatment of posterior urethral injuries is more complicated as they are almost always associated with other severe injuries. Because of these injuries, posterior urethral injuries cannot be definitively repaired at the time of injury. Most urologists leave the catheter placed in the bladder at the time of injury for three to six months to allow for the bleeding from the pelvic fracture to reabsorb. It is also easier to repair the injury after the swelling in the tissues from the injury has subsided. Most posterior urethral injuries require an operation to repair the injury and reconnect the two torn edges of the urethra. This operation is usually performed through an incision in the perineum and continuity of the urethra is reestablished by suturing the two ends of the urethra together.

After the urethra has been repaired, a suprapubic catheter and a Foley catheter placed through the penis into the bladder are left for about three weeks after the operation to allow healing of the urethra. After three weeks, X-rays are performed to be sure that the urethra has healed. If healing has taken place, the catheters are removed. If the X-ray shows persistent leakage, the catheters are left for a while longer.

What can be expected after treatment for urethral trauma?

If a surgical procedure for a urethral injury is performed, catheters are left in the bladder and can be uncomfortable. In addition, pain from unwanted bladder contractions may occur because the bladder is chronically irritated by the catheters.

Once the catheters have been removed, symptoms usually rapidly improve. Although blood in the urine can occur because of irritation from the catheters, it usually disappears after they are removed. Scarring in the area of the urethral repair is the most common and most significant complication. Significant scarring usually causes a decrease in the strength and size of the urine stream and can cause the patient to strain during urination. This can usually be fixed by expanding the scarring with instruments placed up the urethra. However, sometimes the surgical urethral procedure needs to be repeated to prevent further blockage of urine flow.

Frequently asked questions:

Following my operation for a posterior urethral disruption, what are the chances that I will require further surgery?

Most patients do not require further surgery or expansion of urethral scarring following repair.

Will the injury or the surgery result in sexual problems?

The severe injuries that lead to posterior urethral injuries can also damage the delicate nerves that run alongside the urethra deep within the body and provide the signal to the penis to become erect for sexual activity. Approximately 50% of men who have urethral injuries from pelvic fractures will have some degree of erectile dysfunction once they recover. This may range from very mild to complete erectile dysfunction, but several treatment options do exist. Erectile dysfunction caused by the surgery to repair the urethra (rather than the injury itself) is uncommon.

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

A small number of patients (2 to 5 percent) have problems with incontinence following repair of posterior urethral trauma. The reason for this is thought to be damage to nerves that control the bladder outlet at the time of the initial injury and not from the surgery.



Reviewed January 2011

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Urethral Trauma Glossary
  • abdomen: Also referred to as the belly. It is the part of the body that contains all of the internal structures between the chest and the pelvis.

  • abdominal: in the abdomen, the cavity of this part of the body containing the stomach, intestines and bladder.

  • anterior: At or near the front.

  • anus: Opening at the end of the digestive tract where feces (stool) leave the body. The final two inches of the rectum.

  • bladder: The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.

  • catheter: A thin tube that is inserted through the urethra into the bladder to allow urine to drain or for performance of a procedure or test, such as insertion of a substance during a bladder X-ray.

  • chronic: Lasting a long time. Chronic diseases develop slowly. Chronic renal (kidney) failure may develop over many years and lead to end-stage renal (kidney) disease.

  • continence: The ability to control the timing of urination or a bowel movement.

  • contract: To shrink or become smaller.

  • erectile: Capable of filling with blood under pressure, swelling and becoming stiff.

  • erectile dysfunction: Also known as ED or impotence. The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence.

  • erectile dysfunction: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence.

  • gene: The basic unit capable of transmitting characteristics from one generation to the next.

  • gland: A mass of cells or an organ that removes substances from the bloodstream and excretes them or secretes them back into the blood with a specific physiological purpose.

  • hematuria: Blood in the urine, which can be a sign of a kidney stone or other urinary problem. Gross hematuria is blood that is visible to the naked eye. Microscopic hematuria cannot be seen but is detected on a urine test.

  • incision: Surgical cut for entering the body to perform an operation.

  • incontinence: Loss of bladder or bowel control; the accidental loss of urine or feces.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • inflammation: Swelling, redness, heat and/or pain produced in the area of the body as a result of irritation, injury or infection.

  • ions: Electrically charged atoms.

  • pelvic: Relating to, involving or located in or near the pelvis.

  • penis: The male organ used for urination and sex.

  • perineum: The area between the anus and the scrotum in males and the area between the anus and the vagina in females.

  • posterior: Situated at the rear or behind something.

  • posterior urethral trauma: Trauma occurring in the membranous and prostatic urethra. Most commonly associated with pelvic fractures.

  • prostate: A walnut-shaped gland in men that surrounds the urethra at the neck of the bladder. The prostate supplies fluid that goes into semen.

  • pubic bone: Also referred to as the pubis. Lower front of the hip bone.

  • retention: In ability to empty urine from the bladder, which can be caused by atonic bladder or obstruction of the urethra.

  • scrotum: Also referred to as the scrotal sac. The sac of tissue that hangs below the penis and contains the testicles.

  • semen: Also known as seminal fluid or ejaculate fluid. Thick, whitish fluid produced by glands of the male reproductive system, that carries the sperm (reproductive cells) through the penis during ejaculation.

  • semen: The thick whitish fluid, produced by glands of the male reproductive system, that carries the sperm (reproductive cells) through the penis during ejaculation.

  • stent: With regard to treating ureteral stones, a tube inserted through the urethra and bladder and into the ureter. Stents are used to aid treatment in various ways, such as preventing stone fragments from blocking the flow of urine.

  • stricture: Abnormal narrowing of a body passage.

  • suprapubic: An area of the central lower abdomen above the bony pelvis and overlying the bladder.

  • suturing: Closing a wound with a surgical seam.

  • tissue: Group of cells in an organism that are similar in form and function.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urethral: Relating to the urethra, the tube tha carries urine from the bladder to outside the body.

  • urethral stricture: Scarring of tissue that causes narrowing or blockage of the canal leading from the bladder, discharging the urine externally.

  • urge: Strong desire to urinate.

  • urinate: To release urine from the bladder to the outside. Also referred to as void.

  • urination: The passing of urine.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urologist: A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

  • vagina: The tube in a woman's body that runs beside the urethra and connects the uterus (womb)to the outside of the body. Sometimes called the birth canal. Sexual intercourse, the outflow of blood during menstruation and the birth of a baby all take place through the vagina.

Urethral Trauma Anatomical Drawings

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