Urethral Trauma: Causes, Symptoms, Diagnosis, and Treatment Options

The Urethra

The anatomy of the urethra determines the pathology of the urethral trauma. Considering the anatomical divisions, the urethra is divided into anterior and posterior segments. The anterior urethra runs 15 centimeters in length and is distal to the perineal membrane, while the posterior urethra runs 3 centimeters in length and is proximal to the perineal membrane. The anterior urethra is further broken down into the bulbar, penile urethra, fossa navicularis, and urethral meatus from proximal to distal while the posterior urethra includes the bladder neck, prostatic urethra, and membranous urethra from proximal to distal

What is Urethra Trauma

Urethral trauma refers to any injury or forceful damage that occurs to the urethra, which is the tube that carries urine from the bladder out of the body. Most urethral injuries are due to blunt trauma. Penetrating urethral trauma is less common, occurring mainly as a result of gunshot wounds. Falling astride on an object with sudden force on the groin may cause urethral contusion and laceration.

Incidence of Urethra Trauma

Incidence is higher in men. Urethral trauma occurs in approximately 10% of all blunt pelvic trauma injuries and in 35-30% of penetrating injuries to the penis. Approximately 65% of both blunt and penetrating traumatic urethral traumas results in complete urethral disruption, and the remaining 35% results in a partial urethral tear. Motor vehicles accidents accounts for 90% of urethra traumas, and the remaining 10% for falls, crushes, etc.

Types & Aetiology of Urethra Trauma

Anterior urethral trauma:This involves injury to the front portion of the urethra, which is located in the penis in males and the area just above the vaginal opening in females. Anterior urethral trauma is often caused by straddle injuries due to fall or direct trauma to the genital area, or perineal blow.

Posterior urethral trauma:This involves injury to the back portion of the urethra, which is located in the pelvic area. Posterior urethral trauma is usually associated with pelvic fractures or high-energy trauma, such as motor vehicle accidents or falls from heights.

GRADES OF URETHRAL TRAUMA

Grade Istretch injury

Grade IIcontusions with blood at the urethral meatus

Grade IIIpartial disruption of the anterior or posterior urethra

Grade IV complete disruption of the anterior urethra

Grade Vcomplete disruption of the posterior urethra

Causes &Risk factors of Urethra Trauma

• Urethral trauma can be classified as blunt or penetrating including
• Accidents
• Falls
• Pelvic fractures,
• Straddle injuries
• Iatrogenic factors such as catheterization, or certain medical procedures

Pathophysiology of Urethra Trauma

Injury to the posterior urethra occurs when a shearing force is applied at the prostatomembranous junction in blunt pelvic trauma. The prostatic urethra is fixed in position because of the attachments of the puboprostatic ligaments. Displacement of the bony pelvis from a fracture type injury thus leads to either tearing or stretching of the membranous urethra. Anterior urethral injury most often results from a blunt force blow to the perineum, producing a crushing effect on the tissues of the urethra. Urethral injury manifests years later as a stricture. The stricture results from scarring induced by ischemia at the site of the injury. Penetrating injuries also occur in the anterior urethra as a result of external violence.

Signs & Symptoms of Urethra Trauma

• Fever
• Fistula
• Gloss hematuria
• Pain during urination
• Supra pubic pain or tenderness
• Weak urine stream

Diagnostic Investigations of Urethra Trauma

• History and physical examination
• BUE and Creatinine
• Ultrasonography
• Retrograde pyelography
• Retrograde urethrography
• CT Scan / MRI
• Intravenous pyelography

Treatment of Urethra Trauma

Analgesics and antibiotics are used to manage injuries graded 1 and 2 and include; Gentamycin 80mg stat, Ceftriaxone 2g IV start, Cefuroxime 1.5g stat ,Diclofenac 100mg stat; then the required doses continues as prescribed.

Grade 3, 4 and 5 injuries requires surgical interventions which includes; Exploratory laparotomy: this is performed to identify any organs or structures that are affected as a result of the trauma
Bladder drainage via suprapubic cystostomy
Urethroplasty
Suprapubic catheterization (vesicostomy)

Nursing care of Urethra Trauma

Pre operative management

• Strictly monitor intake and output
• Monitor patient for hematuria
• Patient with severe bleeding, grouping and cross matching is done and then transfused
• Maintain patient NPO prior to surgery
• Teach patient deep breathing exercise
• Encourage patient to verbalize fear to allay anxiety
• Explain to the patient some post-opp complications
• Educate the patient about the surgical procedure
• Administer pre-opp medications

Post Opp management

• Monitor vital signs
• Obtain a suitable position for the patient
• Maintain patient intake and output chart
• Monitor and record drainage tube output
• Maintain the position of the drainage tube and it patency.
• Restrict fluid, protein diet and salt intake
• Monitor for flank and abdominal pain
• Perform catheter care
• Ensure complete bed rest
• Administer haematinics to patient with HB less than 7g/dL
• Administer prescribed iv fluids and medications

Complications of Urethra Trauma

• Urethral Stricture
• Impotence
• Peritonitis
• Loss of renal function
• Peri nephritic abscess
• Hypertension
• Pelvic cellulitis