MANAGEMENT OF PELVIC FRACTURE URETHRAL INJURIES IN MEN

Abstract

　　Pelvic fracture urethral injury (PFUI) in men is an uncommon yet debilitating consequence of blunt pelvic trauma. Its mechanism involves major shearing forces at the bulbomembranous urethral junction, resulting in avulsion of the urethra from the fixed urogenital diaphragm. When the pelvis is fractured, the patient often exhibits blood at the urethral meatus, inability to void, bladder distension, and perineal hematoma, which are signs of urethral injury. For unstable patients, the physician may attempt placement of a urethral catheter followed by a suprapubic tube (SPT) if placement failed. Retrograde urethrography should be performed to characterize potential urethral injuries in stable patients. If urethral injury is indicated, primary realignment (PR) of the urethra over a urethral catheter may be performed instead of SPT placement. However, even when PR is successful, most patients will develop urethral stenosis during the first year after injury. The gold standard management for urethral stenosis is delayed urethroplasty performed three to six months after the trauma. When performed using the proper technique, delayed urethroplasty has a high success rate and a low complication rate. In this article, the keys to the management of PFUI are reviewed.