The urethra, the pipe through which urine leaves the bladder, is located in the pelvis and thus can be injured when a person sustains a fracture of the pelvis (such as from motor vehicle accident, fall, or other trauma). This can happen in men or women, although it is much more common in men.
Signs of pelvic fracture urethral injury may include blood at the urinary meatus (opening at the tip of penis) and/or an inability to urinate or pass a catheter into the bladder. A diagnosis may be suspected based on the history and physical examination and requires imaging (retrograde urethrogram or voiding cystogram) for confirmation.
The problem of not urinating must be addressed immediately. Depending on the other injuries the person may have suffered, this may include insertion of a suprapubic catheter (from the abdomen into the bladder), or endoscopic realignment (using a telescope to negotiate a catheter through the urethra). Over time, these patients may develop narrowing (stenosis) of the posterior urethra, incontinence, and/or erectile dysfunction that may require further surgery.