Urethral Bleeding Causes and Diagnosis

Traumatic Causes

Pelvic fractures are the predominant cause of posterior urethral injuries, occurring in 1.5-10% of all pelvic fractures, with concomitant bladder injuries present in 15% of cases 1, 2
The risk of posterior urethral injuries increases by 10% for every 1-mm increase in pubic symphysis diastasis, involving the prostatic or membranous urethra 3
In females, posterior urethral injuries occur almost exclusively from pelvic fractures and should be suspected with labial edema and/or blood in the vaginal vault 1, 4
Straddle injuries occur when the bulbar or penile urethra is crushed between the pubic bones and a fixed object, while penetrating trauma can lacerate, crush, or disrupt the anterior urethra 1, 2

Urethral catheterization is a common iatrogenic cause of urethral bleeding, particularly with traumatic or improper placement, and transurethral surgery is the most common etiology of iatrogenic strictures in men 5
In women, painful or traumatic catheterization and multiple urethral dilations lead to fibrosis from bleeding and extravasation 5

Urethral stricture disease from prior trauma, instrumentation, or lichen sclerosus can present with bleeding, and other causes include obstetric complications, malignancy, radiation, urethral/vaginal atrophy, recurrent infections, and skin diseases like lichen planus in women 5

The American Urological Association recommends that retrograde urethrography must be performed first to confirm the diagnosis and characterize the injury when blood is present at the urethral meatus in trauma cases, as blind catheterization may worsen the injury 1, 2, 6