Injury to the male posterior urethra in fractured pelvis: a new classification.

The present criteria to diagnose a ruptured posterior urethra in cases of a fractured pelvis do not provide accurate information on the degree and site of the urethral injury. A method of retrograde urethrography in such patients is described and the results obtained in 15 cases are reported. On the basis of these results a new classification of membranous urethral rupture in cases of fractured pelvis is proposed: type 1--the prostate or urogenital diaphragm is dislocated but the membranous urethra is merely stretched and not severed, type 2--the membranous urethra is ruptured above the urogenital diaphragm at the apex of the prostate and type 3--the membranous urethra is ruptured above and below the urogenital diaphragm. The clinical significance of these lesions is discussed and a plea is made for the more widespread use of retrograde urethrography in patients with a suspected posterior urethral rupture.