Diagnosis and classification of urethral injuries

Urethral injuries are uncommon and rarely life-threatening in isolation. They are, how-ever, among the most devastating urinary system injuries because of significant long-term sequelae, including strictures, incontinence, erectile dysfunction, and infertility. Urethral trauma may be categorized by mechanism of injury (ie, blunt versus penetrating injury) and by location (ie, posterior versus anterior urethra). Injuries to the posterior urethra are classically associated with pelvic fractures, while anterior urethral trauma usually arises secondary to injudicious instrumentation or perineal straddle injury. This article reviews the major etiologies and mechanisms of urethral trauma, describes how these injuries are diagnosed, and explains classifications of urethral trauma. Timely and accurate diagnosis and classification of urethral injuries leads to appropriate acute management and reduced long-term morbidity.