Table of contents

Expand All Topics

Urethral injury

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of urethral injury are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2025), the World Society of Emergency Surgery (WSES/AAST 2019), and the American Urological Association (AUA 2014).
1
2
3
4

Screening and diagnosis

Diagnosis: as per AAST/WSES 2019 guidelines, evaluate patients with post-traumatic urethral hemorrhage for urethral injuries.
B
Create free account

Diagnostic investigations

Urethrography and urethroscopy
As per EAU 2025 guidelines:
Obtain flexible cystourethroscopy and/or retrograde urethrography for the evaluation of male patients with urethral injuries.
A
Obtain cystourethroscopy and vaginoscopy for the evaluation of female patients with urethral injuries.
A
Create free account

Medical management

Nonoperative management
As per EAU 2025 guidelines:
Perform suprapubic or urethral catheterization for the management of patients with partial blunt anterior urethral injuries, and for the initial management of partial posterior urethral injuries.
A
Perform transurethral or suprapubic catheterization for the initial management of hemodynamically unstable patients with pelvic fracture urethral injuries.
A
Create free account

Therapeutic procedures

Endoscopic urethral realignment
As per EAU 2025 guidelines:
Perform early endoscopic realignment when feasible in male patients with pelvic fracture urethral injuries.
B
Do not repeat endoscopic treatments after failed realignment in male patients with pelvic fracture urethral injuries.
D
Create free account

Surgical interventions

Indications for surgery: as per EAU 2025 guidelines, perform transurethral or suprapubic urinary diversion in patients with iatrogenic anterior urethral injuries.
A
Show 4 more
Create free account

Specific circumstances

Patients with penile trauma
As per EAU 2025 guidelines:
Evaluate for urethral injury in patients with penile fracture.
A
Perform surgery with the closure of tunica albuginea for the treatment of patients with penile fractures.
A
Create free account

Preventative measures

Prevention of iatrogenic injury: as per EAU 2025 guidelines, ensure appropriate training to reduce the risk of traumatic catheterization.
A
Create free account

Follow-up and surveillance

Follow-up: as per AAST/WSES 2019 guidelines, obtain urethroscopy or urethrography as the method of choice for the follow-up of urethral injuries. (GoR 2A.
Create free account