Urotrauma

Page updated Winter 2021.

Disclaimer: Medicine is an ever-changing science. We have been witnessing changes in diagnostic and therapeutic modalities and guidelines during last several years. We have used sources believe to be reliable for purpose of this website including AUA guidelines, EAU guidelines, NCCN guidelines, Campbell-Walsh-Wein Urology, UpToDate, Merck Manual, Lexi-Comp, FDA website, and other reputable sources. However, due to possibility of human error or changes in medicine, readers are required to confirm the information provided in this website with other sources. Readers are specially required to read all parts of the product information sheet included in the package of each drug they plan to administer and follow those instructions. Readers are also needed to follow instructions of FDA and other regulatory bodies and their own department in this regard. Authors can cite information provided in our textbooks or they need to cite the original sources. This website serves as a general framework. We and other users would adjust the approach per departments policies and patients situation. Forms can be used by other health care professionals.

Renal Trauma


Unstable Patients


Immediate intervention is needed.


Surgery


Angioembolization - in selected situations.


Stable Patients


Observation


Ureteral stent


Percutaneous nephrostomy


Percutaneous urinoma drain


Follow-up CT:


- Deep lacerations (Grade IV-V)


- Fever, worsening flank pain, ongoing blood loss, abdominal distention.


Ureteral Trauma


Unstable Patients


Temporary urinary drainage


Stable Patients


Injury above iliac vessels


Primary repair over a ureteral stent.


Injury below iliac vessels


Primary repair over a ureteral stent


Reimplantation. Psoas hitch or Boari flap might be needed.


Contusions


Resection and primary repair


Delayed Diagnosis


Incomplete ureteral injuries


Ureteral stent


Percutaneous nephrostomy: if not able to place a stent.


Endoscopic Injuries


Ureteral stent and/or percutaneous nephrostomy tube.


Open repair if above measures fail.


Ureterovaginal Fistula


Stent


Additional surgical intervention: If stent doesn't help


Bladder Trauma


Intraperitoneal Bladder Rupture


Surgical repair


Extraperitoneal Bladder Injuries


Uncomplicated


Catheter Drainage for two to three weeks.


Consider open repair if bladder injuries don't heal after four weeks.


Complicated


Surgical repair.


Complicated cases include:


- Bladder neck injuries


- Pelvic fractures that result in exposed bone spicules in the bladder lumen


-Concurrent rectal or vaginal lacerations


- Having open reduction internal fixation of pelvis


- Repair of abdominal injuries


Urethral Trauma


Pelvic Fracture Urethral Injury


Percutaneous or Open Suprapubic Tube


Suprapubic cystostomy can be used safely even if anterior pubic hardware is placed.


Primary Realignment


An option in hemodynamically stable patients.


Should not perform prolonged attempts.


Urethral catheter is removed after 4 o 6 weeks.


Suprapubic catheter should be kept.


Straddle Injury to the Anterior Urethra


Percutaneous or Open Suprapubic Tube


Primary Realignment


In less severe cases.


Uncomplicated Penetrating Trauma of the Anterior Urethra


Prompt surgical repair


Primary repair should not be undertaken if


- Patient is unstable


- If there is extensive tissue destruction or loss






Penile Fracture


Prompt surgical exploration and repair is needed.


Evaluate for concomitant urethral injury.


Ventral vertical penoscrotal incision is usually preferred.


Close the tunical defect.


Interrupted 2-0 or 3-0 absorbable sutures is advised.


Deep Penile Electrical Burns


Conservative approach.


Autopenectomy and/or death as a result of extensive concurrent injuries may happen.


Traumatic Penile Amputation


Prompt penile replantation


Penetrating Scrotal Injuries


Prompt surgical exploration with repair is needed.


Perform orchiectomy if non-salvageable.


Testicular Rupture


Perform scrotal exploration and debridement with tunical closure.


Perform orchiectomy if non-salvagable.


Extensive Genital Skin Loss or Injury


From infection, shearing injuries, or burns.


Fournier Gangrene


Limited debridement of non-viable tissue.


Tissues with marginal viability may survive due to collateral blood flow.


Multiple procedures in the operating room are needed.


Wound management options are:


Gauze dressings


Silver sulfadiazine or topical antibiotic and occlusive dressing


Wound vac


Early suprapubic urinary diversion


Genital Burns


Early resection of burn eschar and coverage with split-thickness skin grafts when possible.


Partial-thickness skin loss may be treated with silver sulfadiazine cream.