Rupture of the urethra

Rupture of the urethra (urethral injury) in men occurs much more often than in women. This is due to the anatomical structure of the organ: in women, the urethra is 2 cm long, in men it reaches approximately 23 cm.

The reasons

The cause of a closed injury to the urethra can be a perineal injury, a fracture of the penis, or an instrumental examination. In this case, a complete or partial rupture of the urethra can occur without disturbing the outer integument. A complete rupture of the urethra leads to the fact that when urinating, urine penetrates the tissues of neighboring organs, causing significant complications.

Symptoms

The main signs are urethrorrhagia, sharp pain in the perineum when trying to urinate, partial or complete urinary retention and swelling in the perineal region a few hours after the injury (urohematoma). Complete urinary retention occurs with complete ruptures of the urethra. Sometimes a drop of blood appears at its external opening: a little blood may appear as a result of light pressure on the perineum along the urethra. Out-of-hospital catheterization is not recommended.

With an incomplete rupture, it is sometimes possible to insert a catheter into the bladder, and the first portion of bloody urine is replaced by clear urine and the bladder is completely emptied.

Diagnosis

A more accurate diagnostic method is urethrography: leakage of a contrast agent outside the urethra indicates its rupture.

Treatment

If a patient with a rupture of the urethra has a pronounced overflow of the bladder with urine, then a percutaneous suprapubic puncture of the bladder is performed. Patients with rupture of the urethra are subject to emergency hospitalization in the urological department.

Depending on the period from the moment of injury, concomitant damage to the victim, the primary urethral suture is performed with drainage of the bladder and perineum of the urohematoma. With late hospitalization (over 6 hours after injury), they are limited to percutaneous puncture epicystostomy and drainage of perineal urohematoma.

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