Urinary and genital trauma

Trauma involving the genitourinary system has significant implications for survival and long-term morbidity in affected individuals. The kidney is the most commonly injured urinary tract organ, and while most cases can be managed conservatively, the urologist must be careful to identify and appropriately manage those patients at greatest risk for life-threatening hemorrhage. Although uncommon, ureteral trauma often has an insidious presentation, requiring diagnostic vigilance and timely intervention to avoid prolonged morbidity. Bladder injuries most often occur in association with pelvic fractures, and it is important to clarify the anatomic injury nature and identify potentially complicating factors when determining a surgical or conservative management approach. Urethral and external genital injuries can occur due to a wide variety of mechanisms; by conducting a careful diagnostic investigation and applying reconstructive surgical techniques, the urologist can achieve excellent cosmetic and functional outcomes in many of these cases. In this section, we present an evidence-based approach to the evaluation and management of urologic trauma, highlighting critical management points based upon the American Urological Association’s Urotrauma guideline.