Pediatric Urethral Trauma

  • Etiology:
    — Posterior urethra injury (membranous and prostatic urethra) due to deacceleration injury in MVA
    — Anterior urethra injury (penile and bulbar urethra) due to saddle injury
  • Imaging:
    — Retrograde urethroragram is essential before urethral catheterization
    — Posterior urethra injury often associated with pelvic fracture
  • DDX:
  • Complications: Urinary tract obstruction
  • Treatment: Suprapubic drain
  • Clinical: Presents with inability to void, blood at urethral meatus, perineal or scrotal bruising, elevation of prostate

Radiology Cases of Urethral Trauma

Radiology Cases of Male Urethral Transection

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.

Radiology Cases of Male Urethral Foreign Body and Bladder Stones

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.

Radiology Cases of Female Urethral Laceration and Vaginal Trauma

CT of vaginal laceration and VCUG of urethral laceration
Axial CT with contrast of the lower pelvis (above left) shows a contrast-fluid level in the bladder in the anterior part of the pelvis along with a fluid-filled vagina in the middle of the pelvis that lies anterior to the rectum. There is also free fluid noted around the bladder. At a lower level in the CT (below left) the left wall of the vagina is seen to be completely disrupted and discontinuous. AP image from the voiding phase of a voiding cystourethrogram exam obtained a month later (right) shows contrast leaking out of the left side of the urethra.