Penis Injury and Hematuria in a Man Who Fell on a Log

D. Brady Pregerson, MD


March 19, 2021


Figure 1 shows blood at the urethral meatus, which, in the setting of trauma, should raise an immediate suspicion of genitourinary injury, most specifically a urethral injury. The finding of blood at the meatus is also relevant in that a urethral catheter should not be passed without first performing an RUG. Otherwise, the catheter can unintentionally convert a partial laceration into a full disruption.

Figure 1.

The RUG shows extravasation of contrast from the anterior urethra, consistent with a contained urethral tear (Figure 2). An incidental urethral stricture was also identified; and, because of increased intraluminal pressures from the urethral stricture, contrast medium had to be injected under such force that it was absorbed into the venous plexus (Figure 3).

Figure 2.

Figure 3.

The adult male urethra measures 17-20 cm in length and is divided into 3 sections: the anterior urethra, which is subdivided into the penile (also known as pendulous) and bulbar segments; the short membranous urethra (the portion that passes through the external urethral sphincter); and the posterior or prostatic urethra. Pendulous urethral injuries (such as in this case) are relatively uncommon, consisting of only approximately 10% of lower urinary tract injuries and 37% of all urethral injuries.[1,2]

Unlike posterior urethral injuries, anterior urethral injuries are typically isolated.[3] The anterior urethra may be injured when the penis is compressed against the symphysis pubis during a fall or with a straddle injury (as in this case) or, occasionally, from a direct blow, such as a kick. Posterior urethral injuries most commonly occur as a result of a pelvic fracture from a high-force mechanism. In particular, they are associated with bilateral pubic rami fractures. A posterior urethral injury can also occur without associated pelvic fracture when significant shear forces stretch the urethra at the prostatourethral junction.


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