Patterns of urethral injury and immediate management.

PURPOSE OF REVIEW: The management of urethral trauma remains controversial. The purpose of this review is to provide a concise account of the patterns of urethral injury and the current trends of its immediate management.

RECENT FINDINGS: Recent studies have identified types of pelvic fractures associated with a higher risk of urethral injury. Recognition of these fractures coupled with timely radiographic imaging has facilitated the earlier diagnosis of urethral injury and ensured that serious long-term sequelae are minimized. In highly selected cases of complete anterior and posterior urethral disruption primary realignment by a combined antegrade and retrograde endoscopic approach is increasingly being considered as a management option to restore early urethral continuity. Urethral trauma secondary to penetrating gunshot wounds and penile fracture requires immediate surgical exploration and repair.

SUMMARY: The urologist involved in the management of genitourinary tract trauma needs to recognize the patterns of urethral injury, especially those associated with certain pelvic fractures. A judicious and systematic approach coupled with a conscious effort to minimize short and long-term sequelae of all urethral injuries will ensure optimal results. There is a need for a consensus on the optimal management of each of the vast arrays of urethral injuries.