Urethral Trauma Guidelines

Updated: Dec 06, 2021
  • Author: James M Cummings, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Guidelines Summary

The American Urology Association (AUA) guidelines for diagnosis and management of genitourinary injuries were amended in 2017 and again in 2020 to reflect literature that was released since the original publication in 2014. [28] Key recommendations for urethral trauma include the following:

  • Retrograde urethrography should be performed in patients with blood at the urethral meatus after pelvic trauma.
  • Prompt urinary drainage should be established in patients with either pelvic fracture associated urethral injury or with straddle injury to the anterior urethra.
  • Suprapubic tubes may be placed in patients undergoing open reduction internal fixation (ORIF) for pelvic fracture.
  • Primary realignment may be performed in hemodynamically stable patients with urethral injury associated with pelvic fracture. Prolonged attempts at endoscopic realignment should not be performed.
  • Patients should be monitored for complications (eg, stricture formation, erectile dysfunction, incontinence) for at least one year following urethral injury.
  • Prompt surgical repair should be performed in patients with uncomplicated penetrating trauma of the anterior urethra.
  • Prompt urinary drainage should be established for straddle injury to the anterior urethra.

In 2016, the AUA released guidelines for the diagnosis and treatment of male urethral strictures. [29] For patients with pelvic fracture–related urethral injury, recommendations include the following:

  • Use retrograde urethrography with voiding cystourethrogram and/or retrograde plus antegrade cystoscopy for preoperative planning of delayed urethroplasty after pelvic fracture urethral injury (PFUI). 
  • Perform delayed urethroplasty instead of delayed endoscopic procedures after urethral obstruction/obliteration due to PFUI. 
  • Definitive urethral reconstruction for PFUI should be planned only after major injuries stabilize and patients can be safely positioned for urethroplasty. 

The 2021 European Association of Urology (EAU) urogenital trauma guidelines includes the following recommendations for diagnosis and management of urethral trauma [6] :

  • Evaluate urethral injuries with flexible cystoscopy and/or retrograde urethrography.
  • Treat complete blunt anterior urethral injuries by immediate urethroplasty, if surgical expertise is available; otherwise, perform suprapubic diversion with delayed urethroplasty.
  • Treat partial blunt anterior urethral injuries by suprapubic or urethral catheterization.
  • Treat partial posterior urethral ruptures by suprapubic or transurethral catheterization.
  • Perform early endoscopic re-alignment when feasible. Do not repeat endoscopic treatments after failed re-alignment.
  • Manage complete posterior urethral disruption with suprapubic diversion and deferred (at least three months) urethroplasty.