Traumatic lesions of the posterior urethra

Abstract

Introduction: The posterior urethral lesions are associated with pelvis fractures in 5-10% of cases. The posterior urethra is attached to the pelvis bone by puboprostatic ligaments and the perineal membrane, which explains why disruption of the pelvic ring can injure the urethra at this level.

Objectives: To identify suspected cases of posterior urethral trauma and to perform the diagnosis and its immediate or deferred management.

Acquisition of evidence: Search in PubMed of articles related to traumatic posterior urethral lesions, written in English or Spanish. We reviewed the relevant publications including literature reviews and chapters from books related to the topic.

Synthesis of the evidence: With patients with pelvis fractures, we must always rule out posterior urethral lesions. The diagnostic examination of choice is retrograde urethrography, which, along with the severity of the condition, will determine the management in the acute phase and whether the treatment will be performed immediately or deferred. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction.

Conclusions: Despite the classical association between posterior urethral lesions and pelvic fractures, the management of those lesions (whether immediate or deferred) remains controversial. Thanks to the growing interest in urethral disease, there are an increasing number of studies that help us achieve better management of these lesions.

Keywords: Fractura pelvis; Pelvic fracture; Posterior urethra; Posterior urethroplasty; Traumatismo uretral; Urethral trauma; Uretra posterior; Uretroplastia posterior.