Isolated Urethral Injury Without Penile Fracture: A Case Report

An isolated urethral injury without a penile fracture, particularly one resulting from sexual intercourse, is an infrequent occurrence. Urethral injury without concomitant penile fracture poses a diagnostic dilemma, being an uncommon clinical condition. Early recognition and prompt treatment are essential to prevent complications, which sparked this interest. We report a case of isolated proximal bulbar urethral injury without penile fracture following sexual intercourse in an 18-year-old male who presented with two days of peno-scrotal swelling. An initial diagnosis of bilateral epididymoorchitis was made. During admission, a urethral injury was suspected and subsequently confirmed. A peri-urethral abscess and a right hemiscrotal abscess complicated this injury. He was evaluated using an initial ultrasound testes and subsequently a CT scan of the abdomen and pelvis, and a pelvic MRI due to a diagnostic dilemma. He was treated with antibiotics, underwent urinary diversion via suprapubic cystostomy, flexible cystoscopic-guided urethral catheterisation, and scrotal exploration with drainage of peri-urethral and scrotal abscesses. A subsequent retrograde urethrogram confirmed satisfactory healing. The patient experienced an adequate recovery and healing, and he was followed up for four months without any urinary symptoms. Isolated urethral injuries without an associated penile fracture are uncommon clinical entities. However, when they do occur, they carry a significant risk of complications if not promptly identified. Among the potential sequelae of delayed diagnosis are peri-urethral and scrotal abscesses, which can lead to increased morbidity. These injuries may present atypically, especially following coital trauma, making a high index of clinical suspicion important. Early recognition, supported by appropriate imaging and timely intervention, is key to preventing functional complications. This case highlights the importance of early diagnosis and prompt treatment in optimising patient outcomes and minimising the risk of long-term complications.