Background: The anatomic support of the urethra is controversial. We present a case of an intact urethra and vagina avulsing from the symphysis pubis after pelvic fracture.
Case: An 18-year-old female pedestrian was struck by a motor vehicle. Operative reevaluation revealed an intact vagina and urethra; however, they were avulsed from the symphysis pubis. The avulsed urethra and vagina were reapproximated to the periosteum and surrounding soft tissue circumferentially with no urogenital sequelae.
Conclusion: Complete anterior vaginal wall avulsion may occur with sparing of the lower urinary tract in the setting of pelvic fracture. This case supports the current anatomic understanding of a strong and dense attachment between the urethra and the anterior vaginal wall.