Dr. Benjamin Breyer Urology
San Francisco, CA 94143
Phone: (415) 353-2200
 
     

Benjamin Breyer

Clinics

Urology Practice

400 Parnassus Ave.,
Sixth Floor, Suite A610
San Francisco, CA 94143
Phone: (415) 353-2200
Fax: (415) 353-2641

Hours: Monday to Friday
8 a.m. – 5 p.m.

Request an Appointment

Urethral injuries

Urethral injury is one of the most serious complications of stable and unstable fractures of the pelvis. In most cases, disruption of the bony structure of the pelvis and subsequent urethral injuries are associated with automobile accidents, accidental falls and injuries.

Less commonly, the causes of urethral injury are trauma of the penis, testicles or rectum; endoscopic surgery; penetrating or blunt trauma of the perineum; trauma due to prolonged or improper use of constrictor devices.

Urethral injuries do not create a serious threat to human life, but may destabilize the vital body functions. Therefore, in fractures of the pelvis or other risk factors, a special attention is paid to correct diagnosis of urethral injuries and to prescription of optimal treatment.

The most common symptoms of urethral injuries are urinary retention, pain during urination, inability to urinate, blood in urine, urethral bleeding in the absence of urine, perineal hematoma or edema. When occurring symptoms of urethral injuries, be sure to consult a healthcare professional.

For the diagnosis and classification of urethral injuries, complex medical examination is required. In addition to physical examination, the following diagnostic tests of urethral injuries are needed:

  • Full blood count (FBC) allows identifying the signs of inflammation processes in the body and symptoms of renal dysfunction.
  • Urinalysis (UA) allows identifying the symptoms of inflammation in the urinary tracts.
  • Ultrasound (Sonography) of the kidneys helps to assess the structure and sizes of kidneys and bladder, as well as to identify the symptoms of urinary retention.
  • Computed tomography (CT) helps to identify the localization of the hematomas and edemas, to reveal the signs of displacement of the prostate gland and places of pelvis injuries.
  • Retrograde urethrogram (RUG) and urethrocystoscopy help to determine the location of elongation or rupture of the urethra, as well as correctly to classify urethral injuries.

Guided by the results of physical examination, laboratory and diagnostic tests, the doctor will be able to correctly classify urethral injuries and prescribe the optimal treatment.

Anatomical classification divides urethral injuries into several types, such as urethral contusion; urethral elongation; complete rupture of the anterior and (or) posterior urethra; partial rupture of the walls of the anterior and (or) posterior urethra; rupture of the urethra combined with rupture of the vaginal walls or rupture of the bladder neck.

  • Urethral contusion is an uncomplicated form of urethral injuries that does not require a special treatment.
  • During elongation the urethra or partial rupture of the urethra walls, suprapubic cystostomy or urethral catheter should be established.
  • Complete rupture of the urethra or urethral injuries, complicated by damages of other organs of the urogenital system may require surgical procedures such as cystotomy; urinary catheterisation; urethrotomy, urethral dilatation, urethroplasty, colostomy, endoscopic recanalization.

Besides surgical procedures, drug therapy, which helps to reduce the risk of infectious complications of urethral injuries can be prescribed in elongation and (or) rupture of the urethra. In urethral injuries, the most common infectious complication is urethritis.

To treat and prevent urethritis in urethral injuries, different types of antibiotics can be used.

  • Patients with urethral injuries are most often prescribed with Doxycycline as the first-line antibiotic.

The advantage of this antibiotic is that it has a broad spectrum of antibacterial activity and it is effective in the treatment of serious infections of the urinary tract (UTI) caused by chlamydia and gonorrhoeae.

To reduce the risk of urethra infection and other organs of the urogenital system, an oral dose of Doxycycline 100mg twice daily, for 7 days should be taken.

  • As an alternative to Doxycycline tetracycline antibiotic, patients with urethral injury can be administered with macrolide antibiotic - Azithromycin.

Azithromycin advantage is in the fact that just one dose of this antibiotic (1 gram) should be taken for the urethritis prophylaxis. Azithromycin disadvantage is that many patients rapidly develop resistance to macrolide antibiotics. Therefore, Azithromycin is effective as the first-line therapy, but can be ineffective in frequent relapses of urinary infections.

 
     
 
 
© Dr. Benjamin Breyer