Current Management of Urinary Tract Injuries

Injury to the urinary tract and scrotum can be due to blunt or penetrating trauma. In many circumstances, injuries to the urogenital tract occur in the setting of a polytrauma patient. Therefore, these patients require a multidisciplinary approach. The majority of urogenital injuries are not directly life-threatening and have thus a low priority in the trauma management of a polytrauma patient. Nevertheless, adequate early diagnosis and management are warranted as inadequate diagnosis and treatment can provoke severe long-term complications and invalidity. The standard diagnostic modality of renal (and ureteral) injury is multiphase contrast-enhanced CT if the condition of the patient allows for this. CT cystography is preferred to diagnose bladder injury, whereas retrograde urethrography is the standard for urethral injury. Except in case of hemodynamic instability, renal injury is treated conservatively, if needed, with adjuvant angioembolization. Early recognition of ureteral trauma is crucial as the ureteral injury is usually less complex to repair at that moment. Intraperitoneal bladder injuries need exploration with surgical repair and urinary diversion until bladder healing. Uncomplicated extraperitoneal bladder injuries can be managed by urinary diversion only, until spontaneous bladder healing is achieved. Placement of a suprapubic catheter under echographic or direct vision is always a good solution in the initial management of urethral injury. Early exploration and repair of a testicular rupture are required to salvage the testicle.