Rupture of bulbar urethra: Usually caused by a sudden increase in abdominal pressure e.g. straining to defecate or urinate, or a direct blow to the perineum.
Pathophysiology: The rupture occurs at the weakest point of the urethra which is the bulbar urethra. The force of the blow or the sudden increase in pressure causes the urethral lumen to tear.
Rupture of membranous urethra: Typically caused by a high-velocity injury such as a motor vehicle accident or a fall from a height.
Pathophysiology: The rupture occurs at the level of the urogenital diaphragm where the membranous urethra passes through. The force of the injury causes the urethral lumen to tear.
Clinical Features
Bulbar Urethral Rupture
Sudden onset of severe perineal pain
Difficulty urinating or inability to urinate
Blood at the urethral meatus
Swelling of the perineum
Abnormal urinalysis
Possible presence of a perineal hematoma
Membranous Urethral Rupture
Sudden onset of severe perineal pain
Difficulty urinating or inability to urinate
Blood at the urethral meatus
Swelling of the perineum
Abnormal urinalysis
Possible presence of a perineal hematoma
Complications
Urinary retention
Urinary incontinence
Urethral stricture
Perineal abscess
Sepsis
Kidney damage
Diagnostic Tests and Imaging
Retrograde urethrogram (RUG) to visualize the urethral lumen and identify any tears or strictures
Voiding cystourethrogram (VCUG) to visualize the urethral lumen and bladder during urination
MRI or CT scan to visualize the urethra and surrounding tissues
Urinalysis to check for blood and infection
Blood tests to check for infection and kidney damage
Management of Urethral Rupture
Conservative management: Most patients with a bulbar urethral rupture can be managed conservatively with catheterization and bed rest.
Surgical management: Patients with a membranous urethral rupture or severe bulbar urethral rupture may require surgical repair.
Repair of the tear or stricture
Insertion of a suprapubic catheter to drain the bladder
Administration of antibiotics to prevent infection
Homoeopathic Therapeutic Medicines
Arnica montana: For external injuries and trauma
Belladonna: For symptoms of shock and anxiety
Cantharis: For symptoms of burning and inflammation
Graphites: For symptoms of constipation and stricture
Pulsatilla: For symptoms of urethral discharge and infection
Symphytum: For symptoms of urethral stricture and trauma
Blood Supply
Bulbar urethra: Supplied by the bulbous urethral artery
Membranous urethra: Supplied by the cavernosal artery and the urethral artery
Nerve Supply
Bulbar urethra: Supplied by the pudendal nerve
Membranous urethra: Supplied by the cavernosal nerve and the urethral nerve
Clinical Anatomy
The urethra is a tube-like structure that carries urine from the bladder to the outside of the body.
The bulbar urethra is the part of the urethra that passes through the bulb of the penis.
The membranous urethra is the part of the urethra that passes through the urogenital diaphragm.