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Urethral injury

Key sources
The following summarized guidelines for the evaluation and management of urethral injury are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2023; 2022), the World Society of Emergency Surgery (WSES/AAST 2019), and the American Urological Association (AUA 2014).
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Guidelines

1.Screening and diagnosis

Diagnosis: evaluate patients with post-traumatic urethral hemorrhage for urethral injuries.
B
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2.Diagnostic investigations

Urethrography and urethroscopy
As per EAU 2023 guidelines:
Obtain retrograde urethrography with voiding cystourethrography to evaluate pelvic fracture urethral injuries.
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Obtain retrograde urethroscopy and antegrade cystoscopy as an adjunct to imaging to evaluate pelvic fracture urethral injuries, if further information is required.
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3.Medical management

Nonoperative management
As per EAU 2022 guidelines:
Perform suprapubic or urethral catheterization for the management of patients with partial blunt anterior urethral injuries, and for the initial management of partial posterior urethral injuries.
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Perform transurethral or suprapubic catheterization for the initial management of hemodynamically unstable patients with pelvic fracture urethral injuries.
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4.Therapeutic procedures

Endoscopic urethral realignment
Perform early endoscopic realignment when feasible in male patients with pelvic fracture urethral injuries.
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Do not repeat endoscopic treatments after failed realignment in male patients with pelvic fracture urethral injuries.
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5.Surgical interventions

Indications for surgery: as per EAU 2022 guidelines, perform transurethral or suprapubic urinary diversion in patients with iatrogenic anterior urethral injuries.
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6.Specific circumstances

Patients with penile trauma
As per EAU 2022 guidelines:
Evaluate for urethral injury in patients with penile fracture.
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Perform surgery with the closure of tunica albuginea for the treatment of patients with penile fractures.
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7.Preventative measures

Prevention of iatrogenic injury: ensure appropriate training to reduce the risk of traumatic catheterization.
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8.Follow-up and surveillance

Follow-up: as per WSES 2019 guidelines, obtain ureteroscopy or urethrography as the method of choice for the follow-up of urethral injuries. (GoR 2A.