Traumatic Injury of the Urogenital System

Abstract

The kidney is the most commonly injured genitourinary and abdominal organ. Renal trauma can be life-threatening and a high level of expertise in general surgery, traumatology, and urology is required to prevent mortality and reduce morbidity. However, the majority of renal traumata are mild and can be managed conservatively as a result of advanced imaging and better staging of trauma. In the last two decades, this led to a successive decrease of need for surgical interventions and to an increased renal preservation rate. Trauma to the ureter is relatively rare because of its anatomically protected location, but any ureteral injury can threaten ipsilateral renal function and therefore must be repaired. Among abdominal injuries that require surgical management, about 2% involve the urinary bladder, the most common cause of rupture being blunt trauma associated with pelvis fractures. The male posterior urethra is concomitantly injured in 3.5–19.0% of all pelvic fractures, whereas the female urethra is inflicted in only 0–6%. Most anterior urethral injuries are rarely associated with pelvic fractures and are typically caused by straddle trauma. Due to the variety of injury patterns, the management strategies of urethral injuries remain controversial, but secondary reconstructions with delayed urethroplasty seem to result in better long-term outcomes. Genitourinary trauma with a higher incidence in men than in women, is caused in approximately 80% by blunt injuries, whereas 20% concern penetrating lesions as e.g. stab wounds and gunshot perforations. In the latter group, an accurate and immediate diagnosis and treatment is important in order to preserve the function of genital organs.

This article gives a short review of epidemiology, etiology, diagnosis, and primary treatment of the most common genitourinary trauma.