Genitourinary Injuries

Treatment of Genitourinary Injuries

Temporary Treatment

Urethral catheter. A tube is inserted through the urethra into the bladder, allowing urine to drain from the bladder.

Suprapubic catheter. A tube is placed through the abdominal wall into the bladder to drain urine.

Nephrostomy tube. A tube is placed through the patient's flank (side) to drain urine directly from the kidney (percutaneous nephrostomy).

Ureteral stent. A hollow tube is placed in the ureter, holding it open to maintain urine flow from the kidneys to the bladder.

Definitive Treatment

Many traumatic injuries to the ureters, bladder and urethra require emergency surgery.

Renal (kidney) injury
The majority of traumatic renal injuries can be managed with hospitalization and close observation. Surgery is usually reserved for individuals who have prolonged or severe bleeding from the kidney. Patients with traumatic renal injuries should be re-evaluated three months after injury with repeat X-ray evaluations and blood pressure measurement. These studies are performed to document adequate healing of the kidney and to rule out the development of high blood pressure due to renal fibrosis (scar tissue developing either within or around the kidney).

Ureteral injuries
Ureteral injuries with complete disruption (for example, a gunshot wound that tears the ureter into two pieces) require emergency surgery for repair. Partial ureteral injuries can frequently be managed by a ureteral stent with or without a nephrostomy tube. Nine to 12 months after a ureter injury, X-rays will be taken to be sure that no scar tissue develops within the ureter (ureteral stricture). Follow-up care is important because the development of a ureteral stricture could cause blockage and destruction of the kidney.

Bladder injuries
Bladder injuries that result in urine draining into the abdominal cavity (the peritoneum) or that are associated with a tear through the bladder neck (the opening of the bladder) may require emergency surgery for repair. Occasionally, injuries can be treated without surgery.

If the bladder laceration results in urine leaking around the bladder but not into the peritoneum (and the bladder neck is not injured), the bladder laceration can be managed with a urethral catheter or suprapubic tube without emergency surgery.

After repairing a bladder injury, X-rays are usually performed one to three weeks later, prior to or at the time of removal of the urethral or suprapubic catheter. If imaging reveals abnormal urinary drainage, the catheter may be left in place longer.

Urethral injuries
Urethral injuries may be managed with either emergency surgical repair or a urethral or suprapubic catheter. Some long-term complications from a urethral injury may take years to develop. Patients with a history of a urethral injury may be requested to continue follow-up for a prolonged time to guard against the development of scar tissue (stricture) in the urethra.

Penile injuries
Penile injuries almost always require emergency surgery. Since these injuries frequently coexist with urethral injuries, the doctor usually has to evaluate the urethra when the penis is repaired. If a penile injury is found, the surgeon may not be able to repair the urethral injury during the penile repair, depending on the location, type and extent of injury, other adjacent injuries and the medical condition of the patient.

Testicular injuries
Testicular injuries (testicular fractures) are often suspected following a traumatic blow to the groin or scrotum. If suspected, the doctor will likely perform a testicular ultrasound — but this test is not 100 percent accurate in making the diagnosis of a fractured testicle.

Surgical exploration of the scrotum and possible repair of a fractured testicle is usually recommended whenever a testicular fracture is documented by ultrasound or if the surgeon suspects a testicular fracture could be present and was not diagnosed via the ultrasound.

A few months after a testicular injury, a physical examination and a testicular ultrasound may be done to evaluate blood flow and check for testicular atrophy (shrunken testicle) that may develop despite repair of the fractured testicle.