Management of urethral injury

* Urine extravasation on retrograde urethrogram. A negative retrograde urethrogram effectively rules out urethral injury.

¶ Urethral injury confirmed by inspection or based on intraoperative retrograde urethrogram with or without retrograde cystogram.

Δ For blunt anterior urethral injury, urethral drainage is usually possible. Cystoscopy can be used to aid placement. For blunt posterior urethral injury, the choice of catheter drainage while awaiting definitive repair is debated; either suprapubic catheter drainage or urethral catheter placement (urethral realignment) may be appropriate.

◊ Surgical management of urethral injuries depends on clinical status; control of bleeding from other injuries takes priority over urethral repair. If repair not possible during trauma exploration, provide urinary drainage for later repair or reconstruction. Refer to UpToDate topics discussing specific techniques for urethral repair.