Prostatomembranous urethral disruption and distraction are associated with pelvic fractures in approximately 10% of pelvic fractures. The transmission of shearing forces through the bony pelvis to the membranous urethra results in an avulsion injury at this level that typically results in a defect of varying length, occurring somewhere between the prostatic apex and the departure of the bulbous urethra (Fig. 1). This injury may also occasionally disrupt the prostatic urethra and bladder neck in prepubertal males but is seldom seen in adults. The striated urethral sphincter was previously felt to be invertably damaged in these injuries; however, in many cases, the injury appears distal to the sphincter. The adjacent neurovascular bundles (and erectile function) may also be jeopardized by this injury.

Daniel Rosenstein

The perineal approach to membranous urethral distraction injuries

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