Skip to main content

Trauma & Emergencies

Genitourinary trauma and the urologic emergencies that share the trauma bay include bleeding, ischemia, sepsis, retention and iatrogenic injuries identified intraoperatively by non-urologic teams. The sections below are organized by presentation: initial approach, organ-specific injury, non-traumatic emergencies and operative adjuncts.

Initial Approach​

  • GU Injury OverviewIncidence by organ, mechanism-driven workup, organ-specific injury grading, and the limits of hematuria for excluding injury.
  • Trauma AssessmentATLS-aligned primary and secondary survey, hematuria thresholds, imaging triggers, and the role of the urologist in the trauma bay.

Organ-Specific Trauma​

  • Pelvic Fracture Urethral Injury (PFUI)The page compares male and female PFUI pathways, urinary diversion, repair timing, distraction-defect anatomy, and realignment options.
  • Bladder TraumaIntraperitoneal vs. extraperitoneal rupture, pelvic-fracture associations, CT cystography thresholds, and operative-vs-catheter management.
  • Ureteral TraumaPenetrating-predominant mechanism, intraoperative recognition, location-based repair (UU, ureteroneocystostomy with psoas hitch / Boari, ileal interposition).
  • Renal TraumaAAST grading, selective non-operative management, vascular injuries, angioembolization, and indications for renorrhaphy or nephrectomy.
  • Penile FractureThe page covers tunical rupture, the characteristic pop and detumescence, associated urethral injury, and operative repair timing after delayed presentation.
  • Genital & Scrotal TraumaThe page covers testicular rupture and torsion mimics, penetrating scrotal injuries, traumatic degloving, and vulvar, perineal and pediatric genital trauma.

Non-Traumatic Emergencies​

  • Necrotizing Fasciitis / Fournier's GangreneThe page covers recognition, scoring limitations, antibiotics, debridement extent and repeat operations, and reconstruction with skin grafts, scrotal flaps and perineal closure.
  • PriapismThe page covers ischemic and nonischemic priapism, corporal blood gas, phenylephrine, shunting and penoscrotal decompression, and PDE5 inhibitor evidence for recurrent ischemic episodes.
  • Testicular TorsionTime-to-detorsion outcomes, Doppler limitations, manual detorsion technique, and bilateral fixation at exploration.
  • Acute Urinary RetentionDecompression strategy, difficult-catheterization escalation algorithm (coudé, cystoscopic / guidewire techniques, and SPC), POD recognition, and pre-TWOC alpha-blocker evidence.

Operative Adjuncts & Iatrogenic Injury​

  • Damage Control in Genitourinary TraumaTemporizing kidney, ureter, bladder and urethral maneuvers for the unstable patient, and when to return for definitive repair.
  • On-Table (Single-Shot) IVPOn-table IVP may document a functioning opposite kidney before possible nephrectomy without preoperative CT and guide renal exploration, with limits for injury detection.[1][2]
  • Intraoperative ConsultationIatrogenic urinary-tract injury during non-urologic surgery: when to take the call, diagnostic maneuvers, organ-by-organ repair and the procedures that generate GU injuries.

References​

1. Morey AF, McAninch JW, Tiller BK, Duckett CP, Carroll PR. "Single shot intraoperative excretory urography for the immediate evaluation of renal trauma." J Urol. 1999;161(4):1088-1092. doi:10.1016/S0022-5347(01)61597-0

2. Morey AF, Brandes S, Dugi DD, et al. "Urotrauma: AUA guideline." J Urol. 2014;192(2):327-335. doi:10.1016/j.juro.2014.05.004