Urethral Trauma Guidelines

Updated: Jan 02, 2019
  • Author: James M Cummings, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Guidelines

Guidelines Summary

The American Urology Association (AUA) guidelines for diagnosis and management of genitourinary injuries were amended in 2017 to reflect literature that was released since the original publication in 2014. Key recommendations for the ureteral trauma include [25] :

  • 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 (SPTs) may be placed in patients undergoing open reduction internal fixation (ORIF) for pelvic fracture.
  • Primary realignment (PR) may be performed in hemodynamically stable patients with pelvic fracture associated urethral injury. Prolonged attempts at endoscopic realignment should not be performed.
  • Patients should be monitored for complications (e.g., 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.

In 2016, the American Urology Association (AUA) released guidelines for the diagnosis and treatment of male urethral strictures. For patients with pelvic fracture urethral injury, recommendations include [26] :

  • Use retrograde urethrography with voiding cystourethrogram and/or retrograde + 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 2018 European Association of Urology (EAU) urogenital trauma guidelines includes the following recommendations for diagnosis and management of urethral trauma [5] :

  • Evaluate urethral injuries with flexible cystoscopy and/or retrograde urethrography.
  • Treat blunt anterior urethral injuries by suprapubic diversion.
  • Treat partial posterior urethral ruptures by urethral or suprapubic catheterisation.
  • Perform early endoscopic re-alignment when feasible.
  • Manage complete posterior urethral disruption with suprapubic diversion and deferred (at least three months) urethroplasty.