Urine Leakage due to Trauma ure

A.  Rupture of the superior wall (dome) results in an intraperitoneal extravasation of urine within the peritoneal cavity. It is caused by a compressive force on a full bladder.

B.  Rupture of the anterior wall results in an extraperitoneal extravasation of urine within the retropubic space (of Retzius). It is caused by a fractured pelvis (e. g., car accident) that punctures the bladder.

C.  Type I urethral injury occurs when the posterior urethra is stretched but intact due to the rupture of the puboprostatic ligaments. Type I urethral injuries are rare.

D.  Type II urethral injury occurs when the posterior urethra is torn above the urogenital diaphragm. This results in an extraperitoneal extravasation of urine within the retropubic space of Retzius. It may be caused by a fractured pelvis (e. g., car accident) or improper insertion of a catheter.

E.  Type III urethral injury occurs when the anterior urethra (i. e., bulbous urethra) is torn below the urogenital diaphragm along with a disruption of the urogenital diaphragm so that the membranous urethra is also torn. Radiologists consider a type III urethral injury as a combined anterior/posterior urethral injury. This results in an extraperitoneal extravasation of urine within the superficial perineal space extending into the scrotal, penile, and anterior abdominal wall areas (urine will NOT extend into the thigh region or anal triangle). The superficial perineal space is located between Colles fascia and dartos muscle and the external spermatic fascia. It is caused by a straddle injury (e. g., a boy slips off a bicycle seat and falls against the crossbar) and is the most common type of urine leakage injury Clinical findings include blood at the urethral meatus, ecchymosis, painful swelling of the scrotal and perineal areas, and tender enlargement in the suprapubic region due to a full bladder.

F.  Type IV urethral injury occurs when the neck of the bladder and proximal prostatic urethra are injured. This may result in an extraperitoneal extravasation of urine within the retropubic space of Retzius. Type IV urethral injuries may be serious if the internal urethral sphincter is injured which leads to incontinence.

G.  Type V urethral injury occurs when the penile urethra is torn. This is a pure anterior urethral injury This results in an extraperitoneal extravasation of urine beneath the deep fascia (of Buck) and will be confined to the penis if the deep fascia of Buck is not torn. However, if the trauma also tears the deep fascia of Buck, then extravasation of urine will occur within the superficial perineal space. It is caused by a crushing injury to the penis.

E





F


G





Figure 14-9 Urine leakage due to trauma. A: Rupture of superior wall of urinary bladder. Diagram shows a rupture of superior wall of urinary bladder that results in extravasation of urine into the peritoneal cavity (PC). B: Rupture of the anterior wall of urinary bladder. Diagram shows a rupture of the anterior wall of urinary bladder that results in extravasation of urine into the retropubic space of Retzius. C: Type I urethral Injury. Diagram shows a stretched but intact posterior urethra. Note the rupture of the puboprostatic ligaments (PP). D: Type II urethral injury. Diagram shows a torn posterior urethra above the urogenital diaphragm that results in the extravasation of urine into the retropubic space of Retzius. E: Type III urethral injury. Diagram shows a torn bulbous urethra below the urogenital diaphragm along with a disruption of the urogenital diaphragm so that the membranous urethra is also torn. This results in extravasation of urine within the superficial perineal space. This is the most common type of urine leakage injury and is sometimes called a "straddle injury." F: Type IV urethral injury. Diagram shows injury to the neck of the bladder and the proximal prostatic urethra that may result in extravasation of urine into the retropubic space of Retzius. G: Type V urethral injury. Diagram shows a torn penile urethra that results in extravasation of urine beneath the deep fascia of Buck. PS, pubic symphysis; UG, urogenital diaphragm; P, prostate gland.

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