A man accidentally injured his urethra while riding a bicycle. What should he do?

Author: Tang Qin, Researcher of Chinese Medical Association

Reviewer: Liu Huizhen, deputy chief physician of China Rehabilitation Research Center

Due to the lack of sports-related safety awareness, many men may suffer some accidental injuries when riding bicycles, doing hurdles and other sports. Straddle injuries are one of them. Straddle injuries usually cause acute urethral damage, and in severe cases, even surgical treatment is required.

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1. Types and causes of acute urethral injury

Acute urethral injury is one of the common diseases in urology, which mainly occurs in men.

The male urethra consists of two parts, anterior and posterior, with the urogenital diaphragm in the middle. The anterior urethra is composed of the corpus spongiosum and is divided into the bulbar and penile parts. The posterior urethra is divided into the prostatic and membranous parts. Acute urethral injury can occur in both the anterior and posterior urethra.

1. Anterior urethra injury

The most common type of anterior urethral injury is blunt injury caused by straddling injury, which often occurs when falling from a height or falling down. When the victim suddenly straddles a hard object or the lower body is severely hit, the bulbar urethra may be squeezed and stuck between the hard object and the lower edge of the pubic bone, causing injury. In rare cases, it may also cause injury to the bulbar urethra.

In addition, there are open injuries and ischemic injuries in the anterior urethra. Both types of injuries are relatively rare. The former is generally a penetrating injury such as a gunshot wound or a stab wound, and is occasionally seen in livestock bites and cattle horn stabs, which are often serious injuries. Urethral knife cuts are very rare and are occasionally seen in mentally ill patients or violent criminals. The latter is a urethral injury caused by local compression and reduced circulating blood flow.

2. Posterior urethra injury

The most common type of posterior urethral injury is blunt trauma caused by pelvic fracture, which often occurs in accidents, falls from heights, and severe compression. When the pelvis is fractured, the urogenital diaphragm is suddenly displaced, which can easily injure the posterior urethral membranous part, and is often accompanied by severe trauma to other organs.

Penetrating injuries to the posterior urethra are relatively rare and occur only after severe gunshot or knife wounds.

Generally speaking, anterior urethral injuries are more common, and the injuries are relatively mild and easy to treat. However, posterior urethral injuries are mostly due to combined pelvic fractures and severe trauma to other organs, so the injuries are more serious, the treatment is more complicated, and there are many sequelae.

2. Clinical manifestations of acute urethral injury

Because the location and severity of acute urethral injury are different, the clinical manifestations are also different. If it is just a simple urethral injury, the symptoms will be mild. On the contrary, if it is accompanied by a pelvic fracture, shock may occur, which is manifested as:

1. Pain

When the anterior urethra is injured, there will not only be obvious local pain and tenderness, but it may also extend to the distal end of the penis or perineum, and sometimes the pain will worsen during urination. The pain of posterior urethra injury can radiate to the area around the anus, pubic area and lower abdomen, and there will be obvious tenderness during rectal examination.

2. Bleeding from the urethral opening or hematuria

Anterior urethral injury is manifested by blood dripping or overflowing from the urethra when not urinating, or hematuria at the beginning of urination, especially the first urination after injury. If there is hematuria at the beginning of urination, the anterior urethra is very likely to be damaged. When the posterior urethra is damaged, hematuria will mostly appear at the beginning and end of urination, and even dripping blood at the end of urination.

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3. Difficulty urinating or urinary retention

The severity of dysuria varies depending on the severity of the urethral injury. People with mild contusions generally do not experience dysuria; those with severe contusions or partial urethral ruptures will most likely experience dysuria, and sometimes even complete urine retention after several urinations; those with complete anterior or posterior urethral ruptures will not be able to urinate because the urethra has completely lost continuity. Some people with acute urethral injuries will not experience dysuria immediately after straddle injuries, but scarring will form in the urethra, and the symptom of dysuria will gradually appear.

4. Local hematoma

There is subcutaneous bruising, cyanosis or swelling at the injured site, most obviously in the perineum.

5. Urine extravasation

When patients with acute urethral injury urinate forcefully or frequently, urine leaks out of the tear into the surrounding tissues, which can lead to tissue necrosis, infection, and even worsening of the condition.

6. Shock

Severe urethral injury, especially pelvic fracture with heavy bleeding or combined with other visceral injuries, usually causes shock, among which the incidence of posterior urethral injury combined with shock is higher.

How to treat acute urethral injury

When acute urethral injury occurs, since the treatment methods are relatively professional and difficult for non-professionals to handle, you should go to the hospital for diagnosis and treatment in time to avoid delaying the disease.

For acute urethral injury, doctors will generally conduct detailed interviews, physical examinations and other corresponding examinations on the premise of stabilizing the patient's vital signs, and then choose appropriate treatment methods based on the different types of urethral injury.

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Regardless of the treatment method used, the goal is to prevent and treat shock, infection and complications, drain extravasated urine, and strive to restore urethral continuity as early as possible.

1. Treatment of anterior urethral injury

When the urethra is not completely ruptured, it is treated with a urethral catheter or suprapubic cystostomy. For complete anterior urethral rupture, suprapubic cystostomy or primary repair surgery is used.

If suprapubic cystostomy is used, the injured person needs to be closely observed in the later stage to see whether the urine flow becomes thinner or urination becomes difficult. If such a situation occurs, the patient should seek medical attention immediately, and if necessary, open urethroplasty is needed to restore the normal function of the urethra.

2. Treatment of posterior urethral injury

If the injury is not serious, a urinary catheter or suprapubic cystostomy will be used for treatment. If the injury is serious and there is an open wound, debridement is required; if there is a fracture or damage to the bladder or other organs, surgery will be performed immediately, and urethral realignment will be performed depending on the specific situation.

In the later stages of posterior urethral injury, scar tissue will form at the site of injury, completely blocking the continuity of the posterior urethra rather than simply causing posterior urethral stenosis. Therefore, when the scar tissue becomes stable, urethroplasty is required to restore the continuity of the urethra.

In short, if you encounter acute urethral injury during sports, even if the clinical manifestations are not obvious, you should go to the hospital for regular check-ups, because most of the complications of acute urethral injury occur within 1 year after the injury. Early detection allows early intervention measures and allows you to stay away from the troubles caused by acute urethral injury as soon as possible.

References

【1】Sun Yinghao. Wu Jieping. Urology[M]. Beijing: People's Medical Publishing House, 2019.