Urethral Injury and False Passage Treatment in Jaipur

After an accident, the trauma team first treats bleeding and other injuries, and the orthopaedic team stabilises the pelvis. If urethral injury is suspected, repeated attempts to push a catheter through the penis are avoided, because they can turn a partial tear into a complete one. A retrograde urethrogram (an X-ray with dye put in from the tip) confirms the injury.

Urine is then drained with a suprapubic catheter: a tube placed through the lower tummy straight into the bladder, under local anaesthesia with ultrasound guidance or during other surgery. It keeps the kidneys safe and lets the urethra rest. Some partial tears heal with this alone.

If you have blood at the urine opening after an injury and cannot pass urine, go to the nearest hospital with a trauma service. The repair can be planned later.

Endoscopic realignment in selected cases

In some stable patients, within the first days, telescopes are passed from below through the penis and from above through the bladder to place a guide wire and catheter across the gap. This can make a later stricture shorter or, sometimes, avoid it. Many men still develop a stricture that needs treatment later, so realignment is offered only when it is judged safe.

After a complete tear from a pelvic fracture, the two ends of the urethra usually heal with a block of scar between them. Repair is usually done after about three months, once the blood clot around the injury has cleared, the pelvis has healed and you can lie in the operating position. Until then you live with the suprapubic catheter, which the clinic teaches you to care for.

Before the repair:

• Combined RGU and MCU: dye is put in from the tip of the penis and through the suprapubic catheter at the same time, to show the length of the gap.
• Flexible cystoscopy through the suprapubic tract, to check the bladder neck (the valve at the bladder outlet).
• MRI in some cases, when the anatomy is unclear.
• Urine culture and blood tests, and questions about erections, since the injury itself can affect them.

After a straddle injury, a stricture under the scrotum may form over weeks or months. Short ones are often repaired by anastomotic urethroplasty; selected short ones may be treated with laser DVIU.

1. You receive general or spinal anaesthesia and lie on your back with the legs raised in padded supports.
2. A cut is made in the perineum (between the scrotum and the back passage).
3. The scar between the two ends of the urethra is removed completely.
4. The healthy ends are freed and stitched together without tension (anastomotic urethroplasty). For a longer gap, extra steps shorten the route: separating the two erectile bodies of the penis, removing a small piece of the underside of the pubic bone, or rerouting the urethra.
5. A catheter is left across the repair, with the suprapubic catheter kept for safety.

The operation usually takes 3-4 hours. A graft is rarely needed after pelvic fracture injuries.

Equipment and where it is done

Repairs are done at ManglamPlus Medicity, Shipra Path, Mansarovar, using flexible and rigid cystoscopes, guide wires, X-ray imaging in the operating theatre, fine reconstructive instruments and silicone catheters.

A false passage is a side channel made when a catheter is pushed with force, often in men with an enlarged prostate or an unknown stricture. Signs include bleeding from the urethra, pain, a catheter that does not drain, or a balloon that will not sit in the bladder.

What is done:

• Further blind attempts are stopped.
• A cystoscope is used to find the true channel, a guide wire is passed into the bladder, and a catheter is placed over it. Alternatively, a suprapubic catheter is placed.
• The catheter is usually kept for 1-3 weeks so the false passage can heal.
• Afterwards the urethra is checked for a stricture, which is treated if it forms.

Most small false passages heal with catheter drainage alone. If a catheter cannot be passed easily during urine retention, asking a urologist early helps prevent this injury.

At home: keep the bags below the bladder, drink enough water, avoid constipation, and avoid cycling, two-wheeler riding and heavy lifting for about six weeks.

Call the clinic if you have: fever, a catheter that stops draining or falls out, increasing swelling or bleeding, or a stream that slows again after the catheters are out.

• The narrowing returning: a short recurrence can often be treated with DVIU; a longer one may need a redo repair.
• Erectile problems: common after pelvic fractures, mostly because the accident damages nerves and blood vessels, not because of the repair. Erections can improve over the following months to two years, and erectile dysfunction treatment can help.
• Leakage of urine: uncommon, more likely if the bladder neck was also injured.
• Infection, wound problems and leg numbness from the operating position, reduced by antibiotics, careful wound care and padding.

Because a stricture can return years later, long-term follow-up with flow tests matters, even when you feel well. See the urethral stricture page for symptoms to watch for.