Classification

Posterior urethra injuries are typically classified by the location of the damage on urethrogram. The current classification system is based on a system proposed first by Colapinto and McCallum and later modified by Gold man. Partial and complete injuries use the same classification system. Partial tear of the urethral circumference has been reported to occur with an incidence of 20%-30% [14]. The current classification system is as follows: Type I Posterior urethra intact but stretched. The pu-boprostatic ligaments are ruptured and the prostate is displaced by the resulting hematoma. Type II Partial or complete injury with tear of membranous urethra above the urogenital diaphragm. No contrast is noted in the perineum. Composes 15% of posterior urethra injuries. Type III Partial or complete injury, combined with anterior injury. Disruption of the urogenital diaphragm is noted and contrast is present in the perineum. This is the most common type of injury.

Type IV Bladder neck injury with extension into the urethra. High incidence of internal sphincter injury. Associated with 5% of pelvic fractures in women.

Type IVA Injury of the base of the bladder with periure-thral extravasation. The urethra is intact.

When the urethra elongates but remains intact, it is considered a Type I injury, while partial or complete separation with extravasation above the urogenital diaphragm is noted to be a Type II injury. This has traditionally been identified as the more prevalent type, but Goldman et al. have pointed out that the Type III injury, with extravasation into the perineum, is the more common variety (66%-85%). This type of injury predominantly involves the membranous portion of the urethra and its associated distal sphincteric component. The only active part of the sphincteric mechanism left in patients with Type III posterior urethral injuries is the smooth muscle of the proximal urethral mechanism and the bladder neck area. This becomes the major functioning sphincter anatomy, as clearly established by current urodynamic studies [23, 31].

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