Management of Urethral Trauma During Ejaculation
For urethral trauma occurring during ejaculation, immediately establish urinary drainage with a urethral catheter (if tolerated) or suprapubic catheter, followed by retrograde urethrography to define the injury extent, then pursue conservative management with delayed definitive repair rather than immediate surgical intervention. 1, 2
Immediate Management Priority
Secure urinary drainage as the first and most critical step:
- Attempt gentle urethral catheter placement first if the injury appears partial and there are no contraindications 1, 2
- Place a suprapubic catheter if urethral catheterization fails or causes significant resistance 1, 2
- Do not force catheter passage, as converting a partial rupture into complete transection worsens outcomes 3
Diagnostic Evaluation
Perform retrograde urethrography to define injury location and severity:
- This imaging modality has 95.9% diagnostic accuracy and is the gold standard for urethral injury assessment 1, 2
- Look specifically for blood at the meatus, inability to void, perineal/genital ecchymosis as clinical indicators 4
- Repeat urethrography every two weeks until complete healing is documented 1, 2
Definitive Management Algorithm
Conservative management is the treatment of choice for this mechanism of injury:
- Urethral trauma during ejaculation would be classified as an anterior urethral injury (penile or bulbar urethra), which should be managed conservatively with urinary drainage rather than immediate repair 1, 2
- Initial suprapubic cystostomy followed by delayed reconstruction is superior to immediate urethral realignment for most blunt anterior injuries 5
- Immediate surgical repair is reserved exclusively for penetrating injuries in hemodynamically stable patients with experienced surgeons available 1, 2
Critical Pitfalls to Avoid
Do not attempt immediate surgical repair:
- Immediate sutured repair of urethral injuries is associated with unacceptably high rates of erectile dysfunction and urinary incontinence 4
- Forcing catheter passage can convert partial injuries into complete transections, significantly worsening prognosis 3
- Delaying establishment of urinary drainage increases risk of complications 2
Expected Complications and Follow-Up
Anticipate stricture formation as the primary long-term complication:
- Stricture rates after urethral injury range from 14-100%, with most patients eventually requiring instrumentation or formal urethroplasty 1
- Use urethrography or ureteroscopy for follow-up imaging every two weeks until healing is complete 1, 2
- Delayed urethroplasty (at least 3 months post-injury) is the optimal management for resulting strictures once inflammation and fibrosis have stabilized 6