Urethral trauma. Part II: Types of injury and their management

Abstract

What's known on the subject? and What does the study add? Iatrogenic trauma aside, urethral injuries are not common. Nonetheless, there have been a large number of cohort studies, generally of small numbers of patients.This review pulls together all of the information available to try and produce a coherent narrative.

Management of male pelvic fracture urethral injuries: Review and current topics

“…A cadaveric study showed that the pubic bone and urogenital diaphragm are tightly adherent to the urethra proximal to the striated sphincter, but less adherent distal to the sphincter, resulting in a tendency toward urethral injury at the weaker, more distal point; that is, the bulbar urethra . In contrast to what is seen in adult patients, in children the site of injury tends to be more proximal, including the prostate and the bladder neck, and severe urethral disruption is more likely as a result of anatomical characteristics in children, including the fragile tissues of an immature pelvic structure, the relative intra‐abdominal position of the bladder and an immature prostate . Furthermore, unstable pelvic fractures, such as Malgaigne fractures and straddle fractures, are much more common in children, and the incidence of PFUI after these severe pelvic injuries is higher in children than in adults …”

Self-Inflicted Nailgun-Induced Penetrating Penile Injury: Case Report and Discussion

“…2,10 Clinical features of urethral injury are listed in Table 1. With penetrating penile trauma, urological consultation is strongly advised, even for small lacerations and stab wounds, as surgical urethral closure may be required.…”

“…10,11 Except in cases of clearly superficial tangential injuries, a retrograde urethrogram (ordered during initial assessment by the ED physician) or direct cystoscopy (performed by the urologist during surgical exploration in the operating room) is routinely recommended for all penetrating penile injuries to evaluate for possible urethral injury. Both imaging modalities are recommended in urological trauma guidelines.…”

“…Both imaging modalities are recommended in urological trauma guidelines. 2,10 Additionally, for patients with isolated genital gunshot wounds and no suspicion of associated major injuries, an abdominal radiograph is also required as part of a complete trauma evaluation.…”

Penetrating Trauma to the Ureter, Bladder, and Urethra

“…Prolonged attempts at realignment are discouraged, as they are likely associated with worse incontinence and erectile dysfunction. Patients who are successfully realigned require close follow-up as rate of future stenosis and obstruction approaches 80% 30 . In the setting of urethral injuries where primary realignment is not possible, delayed surgical repair is the recommended treatment.…”