Urethral trauma refers to any injury to the urethra, the tube that carries urine from the bladder to the outside of the body. These injuries may range from mild contusions to complete urethral disruption. Urethral trauma can significantly impact urinary function and often requires prompt medical evaluation and intervention to prevent long-term complications.
Causes of Urethral Trauma
Trauma to the urethra may occur due to:
- Pelvic Fractures: Commonly associated with high-impact injuries such as car accidents or falls. These fractures can tear the membranous urethra.
- Straddle Injuries: Occurs when the perineum strikes a hard surface (e.g., bicycle bars or playground equipment), commonly injuring the anterior urethra.
- Penile Fracture: Sudden bending of the erect penis may also involve the urethra.
- Iatrogenic Trauma: Instrumentation such as difficult catheterization, endoscopic procedures, or surgery may result in urethral injury.
Symptoms
Urethral trauma may present with a variety of symptoms, including:
- Blood at the urinary opening (meatus)
- Inability to urinate
- Pain during urination
- Swelling or bruising in the perineum, scrotum, or penis
- Urine leakage from an abnormal opening (in cases of fistula or complete disruption)
- Hematuria (blood in urine)
- Pelvic or lower abdominal pain
Diagnosis
Prompt and accurate diagnosis is essential for proper treatment. Common diagnostic tools include:
- Physical Examination: May reveal signs of trauma such as blood at the meatus or a distended bladder.
- Retrograde Urethrogram (RUG): A contrast dye study used to evaluate the extent and location of the injury.
- Cystourethroscopy: Endoscopic visualization of the urethra and bladder to assess internal damage.
- Pelvic Imaging: CT or MRI may be used when associated injuries or complex trauma is suspected.
Treatment Options
The treatment approach depends on the location, severity, and timing of the injury:
- Catheter Drainage: For partial injuries, a catheter may be inserted to allow the urethra to heal without surgical repair.
- Suprapubic Catheter Placement: If urethral catheterization is not possible, urine may be diverted through a catheter placed directly into the bladder through the abdomen.
- Delayed Repair: In severe or complete disruptions, surgical reconstruction is often delayed for several weeks to allow inflammation to resolve.
- Urethroplasty: Definitive surgical repair may involve excision of scar tissue and reconstruction of the urethra using tissue grafts or flaps.
Prognosis and Follow-Up
With appropriate management, many urethral injuries can be successfully treated. However, patients are at risk for complications such as:
- Urethral strictures (narrowing due to scar tissue)
- Recurrent urinary tract infections
- Incontinence or urinary retention
- Erectile dysfunction (particularly with posterior urethral injuries)
Long-term follow-up with a urologist is critical to monitor healing and manage any complications that arise. Early intervention and expert care offer the best outcomes for restoring normal urinary and sexual function.