Management of Male Urethral Emergencies

We provide an overview of the terminology, anatomical considerations, pathophysiology, diagnostic evaluation and contemporary management strategies of male urethral emergencies.

We reviewed the literature, including the latest EAU (European Association of Urology) guidelines.

Iatrogenic injuries are the most common cause of urethral injuries. Traumatic injuries are contusion, stretch or partial or complete injury of the anterior and/or posterior urethra. Blunt injuries are most frequently treated initially with suprapubic urinary drainage and, if necessary, subsequent urethroplasty. Early realignment is controversial and can be attempted in stable patients. Except in rare cases most pelvic fracture urethral injuries are treated with delayed anastomotic urethroplasty. For other injuries such as contusions, depending on the length and localization of the fibrotic gap end-to-end anastomosis or augmented urethroplasty is performed. Penetrating or open injuries are variably managed by initial urinary diversion or wound débridement, hematoma evacuation and, if possible, primary urethral anastomosis.

Primary repair of fractured penis is recommended and immediate primary repair is especially important for suspected associated urethral injury.