Genitourinary Tract Injuries

The genitourinary system (or urogenital system) is the organ system of the urinary system and the reproductive organs. These are grouped together because of their proximity to each other and the use of common pathways, like the male urethra.

About 10 percent of all injuries seen in the emergency room involve the genitourinary tract, including the kidneys, bladder, genitals, ureters and urethra.

Symptoms of genitourinary injury differ depending on the location of the trauma. Some common symptoms may include:

  • Inability to urinate
  • Hematuria, a condition in which blood is present in the urine
  • Lower rib fractures
  • Fractures to the pelvic bone
  • Pain and/or bruising involving a person’s side, groin or scrotum

Treatment of genitourinary injuries depends on a number of factors, including the severity, location and type of injury, the patient’s health and whether the patient has any other injuries.

Before a definitive treatment plan is developed, short-term management may be performed. Short-term management may include:

  • Urethral Catheter — A tube is placed into the bladder through the urethra to drain urine.
  • Suprapubic Catheter — A tube is placed through the abdominal wall into the bladder to drain urine.
  • Nephrostomy Tube — A tube is placed through the patient’s flank (side) to drain urine directly from the kidney.
  • Ureteral Stent — A temporary tube is placed through the ureter to connect the kidney to the bladder.

Kidney Injuries

Treatment for kidney injuries depends on the type and severity of the injury, and whether the patient has any other injuries.

  • Blunt Injuries — In 85 percent of cases, injuries to the kidneys are minor, caused by a blunt trauma and do not require surgery. Treatment aims to stop any bleeding from the kidney. Hospital admission, bed rest and hydration are required until bleeding from the kidney stops and urine is clear.
  • Penetrating Injuries — Surgery is more likely for penetrating injuries, such as those from a gunshot wound, which can cause serious bleeding from the kidney. Surgery aims to repair and preserve the injured kidneys. However, if the kidney is severely injured and beyond repair, surgical removal may be required.

Ureteral Injuries

Injuries to the ureters — the tubes that connect each kidney to the bladder — are rare and usually occur during a difficult pelvic surgical procedure or from a gunshot wound. Treatment depends on the type and severity of injury.

  • Complete Disruption — Ureteral injuries that cause complete disruption (the ureter is torn into two pieces) require emergency surgical repair. The best outcome for surgical repair is prompt treatment at the time of injury.
  • Partial Injuries — Partial ureteral injuries, such as those that occur during a pelvic operation, often can be managed by a ureteral stent. Ureteral stents are thin tubes, called catheters, which are inserted into parts of the ureter that carry urine, produced by the kidney, either down into the bladder, or to an external collection system.Ureteral stenting may be placed on a long-term basis, ranging from months to years, to bypass ureteral obstruction. Short-term stenting, ranging from weeks to months, may be placed during an open surgical procedure of the urinary tract to provide a mold around which healing can occur, or to divert the urinary flow away from areas of leakage.

Bladder Injuries

Bladder injuries are most often caused by an accident, such as a car accident, serious fall or a heavy object falling on the lower abdomen. Treatment depends on the type of injury.

  • Contusion Injury — In these types of injuries, the bladder wall is only bruised and does not rupture. Contusion injuries can be managed with a urethral catheter, which is a tube inserted into the bladder through the urethra, so that blood clots pass. Once the urine is clear and the patient stable, the catheter is removed.
  • Extraperitoneal Rupture — These types of injuries can be managed with a urethral catheter to keep the bladder empty and allow the urine and blood to drain out into a collection bag. In most instances, a patient will heal within 10 days. However, large blood clots in the bladder or injuries involving the bladder neck require surgical repair.
  • Intraperitoneal Rupture — These ruptures require surgical repair to prevent urine from leaking into the abdomen. The repair is performed by making an incision in the abdomen and then sewing the tear closed. A catheter is left in the bladder for a few days to rest the bladder after surgery.
  • Penetrating Injuries — Penetrating injuries usually require surgical repair of any holes made in the bladder. In most instances, surrounding organs are injured and also require repair. A catheter is left in the bladder to drain the urine and blood as described above.

Penile Injuries

Penile injuries can occur in various ways. Some penile injuries include:

  • Penile fractures that occur during sexual intercourse. These are usually surgically repaired.
  • Placing obstructing rings around the base of the penis may lead to gangrene and urethral injuries. The obstructing objects can be removed without further damage.
  • Machinery accidents may cause damage to penile skin, which can be repaired by skin grafting.

Penile injuries often occur with urethral injuries. Therefore, when making a diagnosis of penile injuries, an urethrography — a test involving X-rays of the urethra — will be performed to identify any injuries or obstructions in this area.

Testicular Injuries

Testicular injuries often occur due to a traumatic blow to the groin or scrotum, which can cause severe pain, nausea, vomiting and in some instances, lower abdominal tenderness.

In these cases, a testicular ultrasound — a non-invasive test that uses high-frequency sound waves to create images of the testicles and other parts inside the scrotum — is usually performed to evaluate possible damage to the testicle.

If a testicular fracture is diagnosed, surgical exploration and repair is required.