A 20-yrs-old man suffers an injury to the posterior urethra. After appropriate initial management and follow-up care of this injury, the most likely late complication is:
First, I need to recall the anatomy of the urethra. The male urethra is divided into anterior and posterior parts. The posterior part includes the prostatic and membranous urethra, while the anterior is the bulbous and penile. Injuries to the posterior urethra often occur from pelvic fractures or straddle injuries.
Now, the initial management would involve stabilizing the patient, maybe using a suprapubic catheter or a Foley catheter if possible. But the question is about late complications. Common late complications after urethral injuries include strictures, which are narrowing of the urethra due to scarring. This happens because the body's healing process leads to fibrosis in the injured area.
Other possible complications could be urinary incontinence or erectile dysfunction, but those might not be as common. Urethral strictures are a classic late complication because the scar tissue forms a stricture. So the correct answer is likely a stricture.
Looking at the options, even though they aren't listed here, the answer should be stricture. The other options might be things like infection, which is more acute, or bladder neck contracture, which is less common. Diverticula or fistulas might form but are not the most typical late complication.
So the core concept here is the pathophysiology of urethral injury leading to scarring. The key point is that posterior urethral injuries, especially from trauma, lead to strictures due to fibrosis. The clinical pearl would be that urethral stricture is a high-yield answer for such questions.
**Core Concept**
Injuries to the posterior urethra (prostatic/membranous segments) often result from pelvic trauma. The late complication arises from fibrotic healing of the injured tissue, leading to luminal narrowing.
**Why the Correct Answer is Right**
Urethral strictures are the most common late complication due to excessive collagen deposition during wound healing. The membranous urethra, being fixed and less mobile, is particularly prone to scarring. This stricture obstructs urine flow, causing symptoms like hesitancy, weak stream, and post-void dribbling.
**Why Each Wrong Option is Incorrect**
**Option A:** Acute urinary retention is an early complication, occurring immediately after injury due to swelling or clot blockage.
**Option B:** Bladder neck contracture is rare and typically linked to repeated instrumentation or chronic inflammation, not posterior urethral injury.
**Option C:** Erectile dysfunction is uncommon unless there is direct penile trauma or nerve damage, which is not typical of posterior urethral injuries.
**Clinical Pearl / High-Yield Fact**
Remember: "Posterior urethral injury → stricture." Always consider urethroscopy for diagnosis and dilation or grafting for treatment in late cases. Avoid attributing chronic obstruction to less common causes like bladder neck issues.
**Correct Answer: C. Urethral stricture**