案例報告：尿道創傷 – 後續併發症與治療

李昀叡¹、余家政¹、王大齊¹

高雄榮總外科部泌尿外科¹

Case report: Urethral trauma – complication and treatment

Yun-Jui Li¹, Chia-Cheng Yu¹, Ta-Chi Wang¹

¹Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

Introduction:

Bulbous urethral rupture is a form of anterior urethral injury most commonly associated with blunt perineal trauma, such as straddle injuries or direct blows to the perineum. Patients typically present with perineal pain, urethrorrhagia, dysuria, urinary retention, and sometimes perineal hematoma. Prompt diagnosis is essential to prevent complications including urethral stricture, infection, and erectile dysfunction. Retrograde urethrography remains the gold standard diagnostic modality to evaluate the location and extent of injury. Management depends on injury severity and ranges from urinary diversion with suprapubic cystostomy to early endoscopic realignment or delayed urethroplasty. Appropriate timing and surgical planning are critical for optimal functional outcomes.

Case Report:

According to medical records, he was admitted from 114/12/19 to 115/01/03 due to major trauma about bulbourethral rupture. This time, he suffered from urethral opening pain since 01/09, then his suprapubic cystostomy and transurethral foley were both loss of function. Thus, he came to our ER for help. At ER, his vital signs were stable. Lab data showed no leukocytosis but mildly elevated CRP level (1.77). The renal function was also stable (creatinine: 0.54, eGFR: 145.4). Abdominal CT revealed the tip of Foley catheter is located at prostate level, not within the urinary bladder, suspect balloon rupture related. Under the impression of bulbous urethra rupture with obstruction of foley and suprapubic cystostomy, the patient was admitted for further management, including re-alignment of urethra.

Conclusion:

Urethral trauma is an uncommon but clinically significant urologic emergency requiring early recognition and appropriate management to minimize long-term morbidity. Accurate diagnosis, typically with retrograde urethrography, is essential to guide treatment decisions. Management strategies depend on injury location and severity, ranging from catheter realignment to delayed urethral reconstruction. Early urinary diversion and careful follow-up are crucial to prevent complications such as urethral stricture, incontinence, and erectile dysfunction. A multidisciplinary approach and timely surgical intervention can significantly improve patient outcomes. Continued surveillance after treatment remains important to ensure satisfactory functional recovery and quality of life.