Emergency Management of Crushing Perineal Avulsion with Complete Urethral Disruption: A Case Report.

High-energy machinery entrapment can result in catastrophic perineal injuries involving complete urethral disruption, extensive soft tissue avulsion, and associated orthopedic trauma. We report a 24-year-old man who suffered a crushing roller injury, resulting in total perineal avulsion with bilateral testicular exposure, complete bulbar urethral transection, right pubo and ischial ramus avulsion, and an open ipsilateral tibiofibular fracture. Given the patient's hemodynamic stability following resuscitation and the intraoperative finding of cleanly transected urethral ends without rectal or bladder neck injuries, a single-stage surgical approach was pursued. Primary urethral anastomosis and in situ subcutaneous testicular burial were performed, with primary closure of the perineal wound. At 6 months postoperatively, debridement was repeated for non-healing wound secondary to infection, followed by regular dressing changes. Complete healing was achieved at 1 year postoperatively. At the 3-year follow-up, the patient could ambulate independently without assistance, void with a normal stream, and reported preserved erectile function. These favourable outcomes support the value of aggressive early single-stage reconstruction in carefully selected, hemodynamically stable patients sustaining devastating perineal avulsion injuries.