Urethral Trauma

  • Etiology: blunt trauma, 2 types – posterior, anterior
  • Posterior urethra (membranous + prostatic urethra)
    — Etiology: deacceleration injury in MVA
    — Clinical: often associated with pelvic fracture
  • Anterior urethra (penile + bulbar urethra)
    — Etiology: saddle injury
  • Imaging: retrograde urethroragram is essential before urethral catheterization
  • Treatment: suprapubic drain
  • Clinical: signs are inability to void / blood at urethral meatus / perineal or scrotal bruising / elevation of prostate

Cases of Urethral Trauma

VCUG and RUG of urethral transection
AP (upper left) and oblique (upper right) images from a voiding cystourethrogram with the bladder filled through a suprapubic catheter shows extravasation of contrast into the base of the penis when the patient attempts to void. Oblique image from a retrograde urethrogram (below) shows an inability to fill the urethra completely during retrograde injection.
US of urethral trauma
Transverse US of the prostatic urethra (upper left) shows a small round echogenic lesion with posterior shadowing in the center of the prostatic urethra which was not seen in the transverse US of the penile urethra (upper right). Sagittal US of the bladder (lower left) shows an echogenic lesion with posterior shadowing in the posterior aspect of the bladder that on transverse US of the bladder (lower right) resolved into two separate echogenic lesions with posterior shadowing.