This document discusses urogenital trauma, including injuries to the kidney, ureter, bladder, urethra, and external genitalia. It provides details on the prevalence, typical causes, diagnostic techniques like CT scans and cystograms, and surgical and nonsurgical management approaches for each type of injury. Renal injuries are the most common, while ureteral injuries are rare but difficult to detect. Bladder ruptures are often associated with pelvic fractures from blunt trauma. Urethral injuries predominantly affect males and may result in strictures, incontinence or impotence if not properly treated.

1. Liping Xie
Department of Urology, First Affiliated Hospital, School of
Medicine, Zhejiang University
Urogenital Trauma

2. Urogenital Trauma
Renal & Ureteral Injury
Bladder Injury
Urethral Injury
Injuries of the external genitalia
Three to 10% of trauma patients have GU involvement;
10-15% of trauma patients with abdominal injuries have
GU involvement.

3. Renal Injury

4. Renal Injury
Renal injuries constitute 45% of all GU
injuries;
Most renal injuries (80%) are minor and
do not require surgical intervention;
Renal trauma can happen in both blunt
or penetrating trauma;
Renal injuries are most commonly from
motor vehicle accidents (MVAs);

5. Renal Injury Scale

6. Renal Injury
Physical examination:
Flank ecchymosis or mass indicates a
retroperitoneal process but is not specific
to renal injuries and rarely occurs acutely.
– The most important indicator of renal trauma
is gross or microscopic hematuria.
– The absence of hematuria, although rare,
does not exclude renal injury because it is
absent in 5% of patients.

7. Radiographic Staging
IVP - double dose
CT Scan - best method of staging -
radiographic study of choice
Ultrasound
Angiography - used for suspected
renovascular injury
Renal Injury

8. CT Staging for Renal Injury
Right renal stab wound (Grade IV)
Left renal laceration

9. Management of Renal Injury

10. Surgical Management for
Renal Injury

11. Ureteral
Injury

12. Ureteral Injury
Ureteral injuries after external violence are
rare, occurring in less than 4% of cases of
penetrating trauma and less than 1%
cases of blunt trauma.
Ureteral injuries after external violence,
unlike renal injuries, are difficult to detect
with the usual array of diagnostic tools.

13. Ureteral Injury
Excretory urography
demonstrating
extravasation in the
upper right ureter
consequent to stab
wound (Arrow)

14. Surgical Management for
Ureteral Injury

15. Bladder Injury
Bladder injuries classified into contusions,
extraperitoneal and intraperitoneal ruptures ;
Intraperitoneal (20%)
Extraperitoneal (80%)
Rupture
A full bladder is more likely to become injured
than an empty one.

16. Bladder Injury
mostly occur in blunt trauma. Eighty-five
percent of these injuries occur with pelvic
fractures;
15% occur with penetrating trauma and blunt
mechanism without a pelvic fracture (ie, full
bladder blowout).
gross hematuria in the trauma setting requires
imaging of both upper and lower urinary tract

17. Bladder Injury

18. Diagnosis
Cystogram and CT are helpful diagnostic tools. Cystogram (left) shows
extraperitoneal bladder rupture with extravasation into scrotum.
CT(right) reveals intraperitoneal bladder rupture with contrast material
surrounding bowel loops

19. Surgical Mangement of Bladder
Rupture

20. Urethra Injury

21. Urethra Injury
Almost exclusively in male
Most common in straddle injure
Significant morbidity
– Stricture
– Incontinence
– Impotence
Foley catheter implication

22. Urethra Injury
 Gross hematuria in 98%
 Inability to void
 Blood at urethral meatus
 Pelvic / suprapubic
tenderness
 Penile / scrotal / perineal
hematoma
 Boggy / high-riding
prostate/ ill-defined mass
on rectal examination.
 More common than
posterior
 Direct trauma
 Usually NO pelvic injury
 Blood at meatus
 Unable to micturate
 Penile/Scrotal/Perineal
– Contusion
– Hematoma
– Fluid collection
Posterior Urethra- Anterior Urethra-

23. Urethra Injury
EXTRAVASATION OF URINEHigh Riding Prostate on DRE

24. Diagnosis
Urethrogram is the best diagnostic tool-

25. Urethrogram

26. Contrast extravasation + Contrast
in bladder
Contrast extravasation only
Urethrogram
PARTIAL Tear
COMPLETE Tear

27. retrograde
urethrography via
meatus
Extravasation of
contrast medium
with the
“missing”
bladder indicates
a complete tear of
the urethra
Urethrogram

28. Management of Urethral Injury
Partial tear
– careful passage of 12-14 Fr. Foley.
– If any resistance: Urology
Complete tear:
– Urology + suprapubic cath.
If Foley already there and suspect tear:
– LEAVE FOLEY IN PLACE
IInitial urethral repair is not recommendednitial urethral repair is not recommended
because of risk of hemorrhage, impotence, andbecause of risk of hemorrhage, impotence, and
infection of pelvic hematoma.infection of pelvic hematoma.

29. Management of Urethral Injury
Surgical Repair Bank’s Method

30. Penis
– Penetrating, skin avulsion and amputation
repaired surgically
– “fracture” repaired and drained surgically
Scrotum/testes
– Hematocele and contusion (mild) or rupture
(severe, needs exploration)
– Penetrating injuries need exploration
Injuries of the external
genitalia

31. Injuries of the external
genitalia
Penile fracture
scrotal hematoma
after straddle injure