19 year old man presents after an unfortunate incident in a martial arts tournament
Posterior Urethra Tear

• Exam demonstrates extravasation of contrast material into the perineum from the prostatic urethra. There is also a tear of the bulbar urthra
• Type 3 tear is likely most common injury in patients with urethral transection resulting from pelvic fracture 

Urethral Injuries

Types result from complex trauma with pelvic fractures:

• Type 1: urethra intact but narrowed, stretched by periurethral hematoma or partial tear.
• Type 2: Rupture above urogenital diaphragm
• Type 3: Rupture above and below Urogenital Diaphragm

Retrograde Urethrogram

• Posterior Urethra = prostatic + membranous portions
• Anterior Urethra = bulbous and penile portions
• Verumontanum: dorsal elevation inprostatic urethra that receives paired ejaculatory ducts and the utricle
• Membranous Urethra demarcates urogenital diaphragm; radiographically defined as the portion between the distal verumontanum and the cone of the bulbous urethra
• Cowper glands are in the urogenital diaphragm; ducts empty into proximal bulbous urethra
• Littre glands are in the anterior urethra
• Utricle: Mullerian duct remnant. Blind ending pouch in the midline
• Fossa Navicularis: 1-cm long dilatation of distal anterior urethra

 Example of partial tear of the anterior Urethra

This is a partial tear of the anterior Urethra after blunt trauma to the perineum. Open arrow demonstrates extravasation of contrast in the corpus spongiosum.
Solid arrow shows extravastion into the corpus cavernosum from a tear of the penile urethra