IMAGES IN EMERGENCY MEDICINE Complete urethral transection

A 62-year-old carpenter presented to the emergency department with perineal pain, after falling from a height of 5 m and hitting his buttocks against the ground. Physical examination revealed ecchymosis around the perineum and scrotum (figure 1), and gross blood at the urethral meatus. Contrast-enhanced CT showed gluteal haematoma and a linearly enhancing lesion in the corpus spongiosum (figure 2), suggesting arteriovenous fistula. Retrograde urethrography revealed massive extravasation of contrast medium at the junction of the bulbar and penile urethra (figure 3), indicating complete urethral transection. Urethral injury is a common complication of pelvic trauma. Signs suggestive of urethral injury include blood at the meatus, swelling or ecchymosis of the perineum or scrotum, blood in the scrotum, or presence of a high-riding or non-palpable prostate. Retrograde urethrography shows contrast medium extravasation if urethral injury is present.1 Urethral injuries are rarely life-threatening in the acute phase; however, they may lead to long-term morbidity, including urethral stricture, incontinence and impotence, resulting in lower quality of life.2 Management during the acute phase is controversial, comprising either suprapubic cystostomy and interval urethroplasty some months later, or realignment of the urethra.3 This patient underwent suprapubic cystostomy immediately, and interval urethroplasty 6 months later