Introduction/Purpose: The urethra accounts for only 4% of all genitourinary trauma. The bulbar urethra is the most common location of injury and typically results from a straddle type fall or direct blow to the perineum. Patients will classically present with a butterfly hematoma, blood at the urethral meatus and an inability to void. We present the rare case of a 69 year-old male with delayed diagnosis of a urethral straddle injury.
Methods or Case Description: A 69 year-old male presented 4 days after falling onto a ceramic flower pot and sustaining blunt perineal trauma. Since the incident he experienced severe swelling, pain and ecchymosis throughout the entire groin and upper thighs. He had not urinated since prior to the trauma. He was evaluated by his PCP the day following injury and sent home with pain medications but no further work-up was obtained. Initial urological work-up revealed a significantly elevated serum creatinine of 10 and an anterior urethral injury with contrast extravasation into the perineum, scrotum and inguinal soft tissues. Primary urethral realignment and catheter placement via cystoscopy was unsuccessful. Urinary drainage was subsequently obtained with CT guided suprapubic catheter placement.
Outcomes: The patient had significant improvement after successful urinary drainage with normalization of all labs. He was subsequently discharged home with plans for further evaluation and management to be done outpatient.
Conclusion: Although it is common for patients to initially present with complications years after partial urethral injuries, patients who are unable to void after perineal trauma tend to present immediately. It is important to report this case of delayed diagnosis of a urethral straddle injury to better understand the rare presentation and potential consequences.
