A urethral tear, also known as urethral trauma, refers to an injury to the urethra, the tube responsible for carrying urine from the bladder out of the body. This type of injury can affect individuals of any age or gender, though it is more prevalent in men due to anatomical differences in urethral length. A urethral tear requires immediate medical attention to prevent complications and restore normal urinary function.
What is a Urethral Tear?
In males, the urethra extends through the prostate gland and the penis, while in females, it is considerably shorter, running from the bladder to just in front of the vagina.
A urethral tear involves damage to the lining or wall of this tube, disrupting its ability to transport urine effectively. Tears can range in severity from a partial disruption, where some continuity of the urethra remains, to a complete disruption, where the tube is entirely severed. Urethral injuries are broadly categorized by their location: anterior and posterior. The anterior urethra is located in the penis and perineum, the area between the anus and scrotum in men, or between the anus and vulva in women. The posterior urethra, situated deeper within the body, includes the membranous and prostatic urethra, often affected in cases of blunt trauma and pelvic fractures.
How Urethral Tears Occur and Their Signs
Urethral tears commonly result from various types of trauma. Pelvic fractures, often sustained in severe incidents such as car accidents or falls, are a frequent cause, particularly for posterior urethral injuries. Straddle injuries, which occur when an individual falls onto an object like a bicycle crossbar or playground equipment, lead to anterior urethral tears. Medical procedures such as catheterization or endoscopy can inadvertently cause urethral damage. Penetrating trauma, like gunshot wounds, can also result in tears.
Recognizing the signs of a urethral tear is important. The most common symptom is the presence of blood at the tip of the penis in men or at the urethral opening in women, or blood in the urine itself. Individuals may experience difficulty or a complete inability to urinate, or pain during urination. Other indicators include pain in the pelvic or perineal area, along with swelling or bruising around the genitals. In some cases, urine may leak into surrounding tissues, causing further swelling, inflammation, or infection.
Diagnosing and Treating Urethral Tears
Diagnosing a urethral tear begins with a physical examination and a review of the patient’s medical history, particularly any recent trauma. Urinalysis may be performed to check for blood or signs of infection in the urine. The most common and preferred imaging technique for evaluating a suspected urethral injury is a retrograde urethrogram (RUG). This procedure involves gently injecting a water-soluble contrast dye into the urethra, which allows X-ray images to visualize the urethra’s structure and identify any tears or extravasation of the dye outside the urethra.
Treatment approaches vary depending on the severity and specific location of the tear. For minor injuries or bruises without significant urine leakage, a temporary catheter may be placed through the urethra into the bladder for several days, allowing the urethra to heal while diverting urine. More severe tears often require surgical intervention. Options include primary endoscopic realignment, where a guidewire is used to connect the torn ends of the urethra under endoscopic guidance, or open surgical repair, which involves a direct surgical approach to mend the urethra. The primary goals of treatment are to restore normal urinary flow and prevent long-term complications such as strictures or incontinence.
The Recovery Process
Recovery from a urethral tear involves several stages and varies based on the injury’s severity and the chosen treatment. Patients will have a temporary catheter in place, either a Foley catheter inserted through the urethra or a suprapubic catheter placed directly into the bladder through the lower abdomen. This catheter remains 14 to 21 days, or longer, to allow the urethra to heal without urine passing through the injured area. Activity restrictions, such as avoiding strenuous exercise or sexual intercourse, are advised for several weeks to prevent disruption of the healing tissue.
Despite successful initial treatment, certain complications can arise during or after recovery. Urethral stricture, a narrowing of the urethra due to scar tissue formation, is a common long-term issue that can obstruct urine flow and may require further procedures like dilation or urethroplasty. Urinary incontinence, the involuntary leakage of urine, and erectile dysfunction are also potential complications, especially with severe posterior urethral injuries that can damage nerves. Follow-up care with a urologist is important to monitor healing, address any emerging complications, and ensure good long-term outcomes.