Urethral Injuries

Common causes of injury to the urethra include pelvic fractures in men and women and straddle injuries (between the legs) in men. The urethra can also be injured unintentionally during surgical procedures performed directly on the urethra or during procedures in which instruments are passed into the urethra, such as bladder catheterization or cystoscopy (passing a flexible viewing tube through the urethra into the bladder). Rarely, urethral injuries can be self-inflicted when a person inserts a foreign object directly into the urethra.

Some injuries to the urethra are limited to bruising. Injury to the urethra can also tear the lining, resulting in leakage of urine into the tissues of the penis, scrotum, abdominal wall, or perineum (the area between the anus and vulva or scrotum).

Symptoms and Diagnosis

The most common symptoms occurring with a urethral injury include blood at the tip of the penis in men or the urethral opening in women, blood in the urine, and an inability to urinate. Other symptoms may arise when complications develop. If urine leaks into surrounding tissues, infection may result, causing fever and other symptoms. Over time, the injury may cause the urethra to narrow (constrict) near or at the site of injury. When an injury occurs during a surgical procedure, uncontrollable loss of urine (urinary incontinence) may also develop. Men may also experience impairment in the ability to have an erection (erectile dysfunction), caused by damage to the nerves or blood supply to the penis.

If urethral injuries are not treated, complications, such as narrowing of the urethra, persistent infection, urinary incontinence, and erectile dysfunction, may develop.

The diagnosis of a urethral injury is usually confirmed by retrograde urography, an x-ray taken after a radiopaque dye is injected directly into the urethra.

Treatment

For urethral bruises (contusions) that do not result in any leakage of urine, a doctor can place a catheter through the urethra into the bladder for several days to drain the urine while the urethra heals itself. For urethral tears, the urine must be diverted from the urethra using a catheter placed directly into the bladder through the skin over the lower abdomen. The urethra is not repaired surgically until all other injuries have healed or for at least 8 to 12 weeks (when inflammation has resolved).

Treatment helps to prevent complications of urethral injuries. Complications must be treated if efforts to prevent them are unsuccessful.