Urethral Injuries from pelvic fracture

Urethral injuries from pelvic fractures don't happen very often. It mainly happens because of vehicle accidents, industrial accidents, or straddle falls. Dealing with this type of trauma may require immediate or delayed urinary reconstruction.

Along with the lower urinary system trauma (bladder, prostate, and urethra), pelvic trauma may disrupt nerves to the bladder and penis that lead to a urinary issues like leakage and erectile dysfunction.

It can happen to men and women; it is more common in men.

• Urethral trauma
• Bladder trauma & incontinence
• Erectile dysfunction

• Blood in the urinary meatus (i.e, opening at the tip of the penis)
• Inability to urinate
• Urine building up in the bladder
• Swelling
• Inflammation
• Infection
• Pain in the belly
• For men- the symptom is a drop of blood at the tip of the penis, swelling and bruising of the penis, scrotum, and perineum might occur along with pain in that area.

Trauma to the anterior urethra can be caused by straddle injuries, bicycle seats, or playground equipment.

Trauma to the posterior urethra can be caused by pelvic fractures such as:

• Vehicle accidents
• Crush injuries
• Falling from a height
• Bullets
• For women, urethral injuries may happen due to sexual assault.

The above symptoms need to be addressed immediately. The doctor may perform a physical examination, he may pass a catheter through the urethra. If there is any difficulty passing the catheter into the urethra is the first sign of urethral injury.

Imaging tests like retrograde urethrogram or voiding cystogram, MRI, Ultrasound, cystoscopy, X-ray of the urethra are performed.

Surgery:

Surgery to reconnect the urethra is done after three months of the trauma. The posterior urethral injury treatment is very complicated.

Till then, patients need to have a catheter draining the bladder. Patient may need a Supra pubic Catheter (SPC) placed below the belly button. This helps the body to reabsorb the bleeding from the pelvic fracture. It will be easier to fix the urethra after swelling in the tissues that occurred due to pelvic fracture comes down. Many posterior urethral injuries require an operation to connect 2 torn edges of the urethra. This is done through a cut in the perineum.

In case the urethra has completely torn away, urine has to be drained. This is done with the help of a tube stuck into the bladder through the skin (suprapubic). This catheter goes through the skin just above the pubic bone in the lower belly into the bladder. The tube is inserted at the time of abdominal surgery, or it is done through a small puncture. An X-ray is used to check the catheter is in the bladder. The doctor may suggest a procedure to rejoin the torn urethra over a catheter, which will help it heal.

After surgery:

Post-surgery a catheter is left in the bladder which can cause difficulty to the bladder and may cause it to contract on its own, due to this some blood is seen in the urine. These symptoms will go away once the catheter is removed.

You will have follow-up visits with the urologists to make sure you don't develop erectile dysfunction or urinary incontinence issues.