Skip to main content

Etiology, Mechanisms, and Anatomopathology of Urethral Injury

  • Chapter
  • First Online:
Urogenital Trauma: A Practical Guide
  • 130 Accesses

Abstract

An old consensus from WHO experts recommended the term “stricture be used for the anterior urethra in cases with intrinsic corpus spongiosum fibrosis (spongiofibrosis) while the urethra remains in continuity. Conversely, they recommended the terms “stenosis” for the posterior urethra, and especially the term “sphincter stenosis” for simple continuity strictures of the membranous urethra (such as those from TURP or secondary to inflammations) or for those occurring after radical prostatectomy and urethra-vesical anastomosis, in order to emphasize that the distal urethral sphincter mechanism has not been destroyed although its function might be generally impaired to a variable extent. When there are more serious injuries of the posterior urethra (such as those arising from a pelvic fracture), the term “PFUDD” (pelvic fracture urethral distraction defects) was preferred [1].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Chapple C, Barbagli G, Jordan G, Mundy AR, Rodrigues-Netto N, Pansadoro V, McAninch JW. Consensus statement on urethral trauma. BJU Int. 2004;93(9):1195–202. https://doi.org/10.1111/j.1464-410x.2004.04805.x. PMID: 15180604.

    Article  PubMed  CAS  Google Scholar 

  2. Gómez RG, Mundy T, Dubey D, El-Kassaby AW, Firdaoessaleh KR, Santucci R. SIU/ICUD consultation on Urethral strictures: pelvic fracture urethral injuries. Urology. 2014;83(3 Suppl):S48–58. https://doi.org/10.1016/j.urology.2013.09.023. Epub 2013 Nov 8. PMID: 24210734.

    Article  PubMed  Google Scholar 

  3. Palminteri E, Berdondini E, Verze P, De Nunzio C, Vitarelli A, Carmignani L. Contemporary urethral stricture characteristics in the developed world. Urology. 2013;81(1):191–6. https://doi.org/10.1016/j.urology.2012.08.062. Epub 2012 Nov 13. PMID: 23153951.

    Article  PubMed  Google Scholar 

  4. Alwaal A, Blaschko SD, McAninch JW, Breyer BN. Epidemiology of urethral strictures. Transl Androl Urol. 2014;3(2):209–13. https://doi.org/10.3978/j.issn.2223-4683.2014.04.07. PMID: 26813256; PMCID: PMC4708169.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Alwaal A, Zaid UB, Blaschko SD, Harris CR, Gaither TW, McAninch JW, Breyer BN. The incidence, causes, mechanism, risk factors, classification, and diagnosis of pelvic fracture urethral injury. Arab J Urol. 2015;13(1):2–6. https://doi.org/10.1016/j.aju.2014.08.006. Epub 2014 Sep 16. PMID: 26019970; PMCID: PMC4435767.

    Article  PubMed  Google Scholar 

  6. Stein DM, Thum DJ, Barbagli G, Kulkarni S, Sansalone S, Pardeshi A, Gonzalez CM. A geographic analysis of male urethral stricture aetiology and location. BJU Int. 2013;112(6):830–4. https://doi.org/10.1111/j.1464-410X.2012.11600.x. Epub 2012 Dec 18. PMID: 23253867.

    Article  PubMed  Google Scholar 

  7. Kashefi C, Messer K, Barden R, Sexton C, Parsons JK. Incidence and prevention of iatrogenic urethral injuries. J Urol. 2008;179(6):2254–7. https://doi.org/10.1016/j.juro.2008.01.108; discussion 2257–8. Epub 2008 Apr 18. PMID: 18423712.

    Article  PubMed  Google Scholar 

  8. McGeady JB, Breyer BN. Current epidemiology of genitourinary trauma. Urol Clin North Am. 2013;40(3):323–34. https://doi.org/10.1016/j.ucl.2013.04.001. Epub 2013 Jun 12. PMID: 23905930; PMCID: PMC4016766.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Najibi S, Tannast M, Latini JM. Civilian gunshot wounds to the genitourinary tract: incidence, anatomic distribution, associated injuries, and outcomes. Urology. 2010;76(4):977–81; discussion 981. PMID: 20605196. https://doi.org/10.1016/j.urology.2010.01.092.

    Article  PubMed  Google Scholar 

  10. Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 2002;195(1):1–10. https://doi.org/10.1016/s1072-7515(02)01197-3. PMID: 12113532.

    Article  PubMed  Google Scholar 

  11. Webster GD, Mathes GL, Selli C. Prostatomembranous urethral injuries: a review of the literature and a rational approach to their management. J Urol. 1983;130(5):898–902. https://doi.org/10.1016/s0022-5347(17)51561-x. PMID: 6355512.

    Article  PubMed  CAS  Google Scholar 

  12. Koraitim MM, Marzouk ME, Atta MA. Risk factors and mechanism of urethral injury in pelvic fractures. Br J Urol. 1996;77(6):876–80.

    Article  PubMed  CAS  Google Scholar 

  13. Turner-Warwick R. Complex traumatic posterior urethral strictures. J Urol. 1977;118(4):564–74. https://doi.org/10.1016/s0022-5347(17)58109-4. PMID: 916051.

    Article  PubMed  CAS  Google Scholar 

  14. Mouraviev VB, Santucci RA. Cadaveric anatomy of pelvic fracture urethral distraction injury: most injuries are distal to the external urinary sphincter. J Urol. 2005;173(3):869–72. https://doi.org/10.1097/01.ju.0000152252.48176.69. PMID: 15711300.

    Article  PubMed  Google Scholar 

  15. Andrich DE, Mundy AR. The nature of urethral injury in cases of pelvic fracture urethral trauma. J Urol. 2001;165:1492–5.

    Article  PubMed  CAS  Google Scholar 

  16. Bjurlin MA, Fantus RJ, Mellett MM, Goble SM. Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank. J Trauma. 2009;67(5):1033–9. https://doi.org/10.1097/TA.0b013e3181bb8d6c. PMID: 19901665.

    Article  PubMed  Google Scholar 

  17. Koraitim MM. Pelvic fracture urethral injuries: the unresolved controversy. J Urol. 1999;161(5):1433–41. PMID: 10210368.

    Article  PubMed  CAS  Google Scholar 

  18. Alwaal A, Zaid UB, Blaschko SD, Harris CR, Gaither TW, McAninch JW, Breyer BN. The incidence, causes, mechanism, risk factors, classification, and diagnosis of pelvic fracture urethral injury. Arab J Urol. 2015;13(1):2–6. https://doi.org/10.1016/j.aju.2014.08.006.

    Article  PubMed  Google Scholar 

  19. Koraitim MM. Posttraumatic posterior urethral strictures in children: a 20-year experience. J Urol. 1997;157(2):641–5. PMID: 8996388.

    Article  PubMed  CAS  Google Scholar 

  20. Clark SS, Prudencio RF. Lower urinary tract injuries associated with pelvic fractures. Diagnosis and management. Surg Clin North Am. 1972;52(1):183–201. https://doi.org/10.1016/s0039-6109(16)39642-6. PMID: 5013219.

    Article  PubMed  CAS  Google Scholar 

  21. Iselin CE, Webster GD. The significance of the open bladder neck associated with pelvic fracture urethral distraction defects. J Urol. 1999;162(2):347–51. PMID: 10411036.

    Article  PubMed  CAS  Google Scholar 

  22. Rosenstein DI, Alsikafi NF. Diagnosis and classification of urethral injuries. Urol Clin North Am. 2006;33(1):73–85. https://doi.org/10.1016/j.ucl.2005.11.004, vi-vii. PMID: 16488282.

    Article  PubMed  Google Scholar 

  23. Pokorny M, Pontes JE, Pierce JM Jr. Urological injuries associated with pelvic trauma. J Urol. 1979;121(4):455–7. https://doi.org/10.1016/s0022-5347(17)56822-6. PMID: 439217.

    Article  PubMed  CAS  Google Scholar 

  24. Mundy AR, Andrich DE. Urethral trauma. Part I: introduction, history, anatomy, pathology, assessment and emergency management. BJU Int. 2011;108(3):310–27. https://doi.org/10.1111/j.1464-410X.2011.10339.x. PMID: 21771241.

    Article  PubMed  Google Scholar 

  25. Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br. 1988;70:1–12.

    Article  PubMed  CAS  Google Scholar 

  26. Andrich DE, Day AC, Mundy AR. Proposed mechanisms of lower tract injury in fractures of the pelvic ring. BJU Int. 2007;100:567–73.

    Article  PubMed  Google Scholar 

  27. Priyadarshi V, Gupta D, Pal DK. Lower genitourinary tract trauma caused by Cow Horn injury. J Obstet Gynaecol India. 2016;66(Suppl 1):578–82. https://doi.org/10.1007/s13224-015-0748-z. Epub 2015 Sep 8. PMID: 27651664; PMCID: PMC5016394.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

AL-Mamari, S.A. (2023). Etiology, Mechanisms, and Anatomopathology of Urethral Injury. In: Urogenital Trauma: A Practical Guide. Springer, Singapore. https://doi.org/10.1007/978-981-99-6171-9_28

Download citation

  • DOI: https://doi.org/10.1007/978-981-99-6171-9_28

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-6170-2

  • Online ISBN: 978-981-99-6171-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics