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Urologic trauma guidelines: a 21st century update

Nature Reviews Urology volume 7, pages 510–519 (2010)Cite this article

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Abstract

Trauma is the leading cause of death between the ages of 1 and 44 years in the USA. While stabilization of life-threatening injuries is the primary goal in the evaluation of all trauma patients, subsequent diagnosis and treatment of secondary injuries are requirements for good trauma care. The genitourinary system is involved in 10% of trauma cases, and these injuries can be associated with considerable morbidity and mortality. Accordingly, physicians involved in the initial evaluation and subsequent management of trauma patients should be aware of the diagnosis and treatment of injuries that can occur in the genitourinary system. In 2009, the European Association of Urology provided specific recommendations for the evaluation, diagnosis and management of genitourinary trauma. Here, we review and discuss these recommendations in order to provide a concise summary for clinicians involved in the evaluation and management of trauma patients and their associated genitourinary injuries.

Key Points

  • The genitourinary system is involved in 10% of all trauma cases

  • The kidney is the most commonly injured abdominal organ in cases of trauma, but most injuries are managed nonoperatively

  • Ureteral injuries are often iatrogenic; diagnosis requires high clinical suspicion and site-specific repair

  • Bladder injuries are associated with pelvic fractures, which may be life threatening; extraperitoneal injuries can be managed with catheter drainage, while intraperitoneal injuries require open repair

  • Catheter realignment can be successful in patients with urethral injuries; posterior distraction defects require delayed primary urethroplasty, while open anterior injuries require immediate exploration and primary repair

  • External genital injuries can be diagnosed by history and physical examination; emergent exploration and repair is indicated in cases with marked hematoma, penile fracture or testicular disruption

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Figure 1: Abdominal CT with intravenous contrast.
Figure 2: Abdominal CT with intravenous contrast.
Figure 3: Abdominal CT of a patient with a penetrating injury of the right kidney.
Figure 4: Retrograde pyelography of a patient with suspected left ureteral injury.
Figure 5: Surgical repair of an intraperitoneal bladder injury.
Figure 6: Retrograde urethrography in a patient with urethral injury.
Figure 7: Posterior urethral distraction injury repaired with delayed urethroplasty.

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Laurie Barclay, freelance writer and reviewer, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Michigan State College of Osteopathic Medicine, Harper Professional Building, Suite 1017, 4160 John R. Street, Detroit, 48201, MI, USA

    Richard A. Santucci

  2. Michigan State College of Osteopathic Medicine, Botsford Hospital, 28050 Grand River Avenue, Farmington Hills, 48336, MI, USA

    Jamie M. Bartley

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Santucci, R., Bartley, J. Urologic trauma guidelines: a 21st century update. Nat Rev Urol 7, 510–519 (2010). https://doi.org/10.1038/nrurol.2010.119

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