The urethra is a tube that allows urine to exit the bladder. In males, it also carries semen. While “broken urethra” isn’t a precise medical term, the urethra is vulnerable to injury and rupture. These injuries can significantly impact urinary function and overall health.
Understanding Urethral Injuries
When people refer to a “broken urethra,” they are describing a urethral injury or rupture. These injuries range in severity from a minor bruise (contusion) to a partial tear, or even a complete disruption where the urethra is fully severed. A contusion involves superficial damage, while a partial disruption means the tube is torn but still has some continuity. A complete disruption signifies a full tear, separating the ends of the urethra.
Such injuries impair the urethra’s ability to transport urine effectively, leading to blockages or leakage. The injury’s location also plays a role, with trauma affecting the posterior urethra (closer to the bladder) often differing from injuries to the anterior urethra (further down).
Common Causes of Urethral Injury
Urethral injuries result from external forces or medical procedures. Blunt trauma to the pelvis, such as from car accidents, crush injuries, or falls, is a common cause, often leading to pelvic fractures. These fractures can cause the posterior urethra to shear or tear. Approximately 10% of blunt pelvic trauma injuries result in urethral disruption.
Another mechanism is a “straddle injury,” occurring when a person falls onto a hard object like a bicycle crossbar or fence. This injury usually affects the anterior urethra, compressing it against the pubic bone. Penetrating injuries, such as gunshot or stab wounds, can also directly damage any part of the urethra.
Urethral injuries can also be iatrogenic, meaning inadvertently caused by medical procedures. Traumatic catheterization, where a urinary catheter is inserted improperly, is a common iatrogenic cause. Other medical procedures like endoscopy or surgery can also lead to accidental urethral damage.
Recognizing a Urethral Injury
Identifying a urethral injury involves observable signs and symptoms. A primary indicator is blood at the urethral opening, particularly in men, or blood visible in the urine (hematuria). Patients may also experience difficulty or an inability to urinate, known as urinary retention.
Pain in the lower abdomen, pelvis, or perineum (the area between the genitals and anus) is common. Swelling or bruising in the perineal area or scrotum can also be present. In severe cases, urine may leak into surrounding tissues, leading to a palpable mass or swelling in the perineum. Any of these symptoms after an injury should prompt immediate medical evaluation.
Diagnosis and Treatment Approaches
Diagnosing a urethral injury begins with a physical examination and assessment of the traumatic event. The gold standard imaging test is a retrograde urethrography (RUG). This procedure involves injecting contrast dye into the urethra, and X-ray images are taken to visualize the urethra and detect leakage, indicating a tear or rupture.
Computed tomography (CT) scans may also be used, especially in blunt trauma cases, to assess broader abdominal and pelvic areas; however, RUG specifically evaluates the urethra. Once diagnosed, treatment depends on the injury’s severity and location. Minor injuries like contusions may be managed non-surgically with temporary catheter placement to allow healing.
For partial or complete tears, more involved interventions are necessary. A suprapubic catheter, which drains urine directly from the bladder through a small abdominal incision, is often placed to divert urine and allow the urethra to heal. Surgical repair, such as primary end-to-end anastomosis, may be performed for complete ruptures, reconnecting the torn ends. Delayed surgical repair, known as urethroplasty, is also common for complex injuries or those developing into strictures.
Potential Long-Term Health Impacts
Urethral injuries can lead to lasting health complications if not properly managed. A common long-term effect is urethral stricture, a narrowing of the urethra due to scar tissue. Strictures can cause a weak or slow urine stream, difficulty emptying the bladder, and may require further interventions.
Urinary incontinence, or difficulty controlling urine, can also develop, especially after severe injuries or complex repairs. Another concern, particularly in men with pelvic trauma-associated urethral injuries, is erectile dysfunction. This can result from damage to nerves or blood vessels supporting erectile function. Studies suggest up to 34% of patients with pelvic fracture urethral injury may experience erectile dysfunction.
Recurrent urinary tract infections (UTIs) are also a potential long-term issue, as altered anatomy or impaired urine flow can create an environment conducive to bacterial growth. Abnormal connections called fistulas can form between the urethra and other organs or the skin, leading to chronic leakage.