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Urethral Injuries

If the urethra is injured, a person may develop urethra obstructions or strictures. Urethral strictures occur when the urethra is injured or scarred by an infection and then narrows. As a result, problems with the normal passage of urine and semen can develop.

Urethral injuries can have devastating long-term consequences, such as potential complications of impotence, stricture and incontinence.

Injuries may affect either the anterior or posterior part of the urethra. In most cases, anterior urethral trauma is characterized as a blunt injury to the perineum — the area between the genitals and anus — since the urethra is located near the skin in this area. This type of trauma is often the result of straddle-like injuries, such as when a child forcefully straddles a bicycle or fence. Penetrating injuries to the anterior urethra, such as those from a gunshot wound, also may cause strictures or obstructions.

Posterior urethral trauma affects the part of the urethra that travels inside the body. This type of trauma almost always occurs as a result of pelvic fractures following automobile accidents, serious falls or industrial crash injuries.

Injuries that cause significant damage to the urethra may lead to urinary strictures or obstructions. As a result, a person may experience a variety of symptoms, including:

  • Weak or slow urine stream
  • Dribbling
  • Urinary frequency
  • Urgency to urinate
  • Nocturia, a condition in which a person has to urinate frequently during the nighttime
  • Urinary retention

In making a diagnosis of urethral injury, your doctor will begin by asking about any events that may have caused trauma to the urethra, including a pelvic fracture, straddle injury or penetrating injury near the urethra, such as a gunshot wound. A thorough physical examination will then be conducted to check for any symptoms associated with urethral injuries. Blood along the perineum or at the meatus, which is the opening of the urethra, are signs of injury. A high-riding prostate gland also may indicate injury to the urethra.

A retrograde urethrogram also may be performed. This imagining test is commonly performed to diagnose urethral injury or narrowing. It is performed in a hospital radiology department, operating room or in a health care provider's office by an X-ray technician under a physician's supervision. There is no special preparation required. Dye is injected directly into the urethra and X-rays are taken to check for injury or narrowing.

Treatment of urethral injuries can be complex and depends on a number of factors, including:

  • Severity and location of injury
  • Patient's health
  • Whether any other injuries are present

In some cases, emergency surgical repair is recommended, but should be limited to select cases. As a general rule, initial suprapubic cystostomy, which involves placing a catheter in the bladder through the lower abdomen, is the safest and simplest option.

Once the urethra has begun to heal, your doctor will reassess your injury and develop a definitive treatment plan. Reconstructive surgery or the placement of a urethral or suprapubic catheter, which is a tube inserted into the bladder to help drain urine, may be recommended. At UCSF Medical Center, patients who undergo reconstructive surgery have a high success rate for urethral function and cosmetic appearance.

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Reviewed by health care specialists at UCSF Medical Center.

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Urology

Urology Practice
400 Parnassus Ave., Sixth Floor, Suite A610
San Francisco, CA 94143
Phone: (415) 353-2200
Fax: (415) 353-2641
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