Genitourinary trauma

Genitourinary (GU) organs are commonly injured in trauma patients. Although the kidney is the most commonly injured organ, other GU structures such as the bladder and urethra are also susceptible to injury. GU trauma is broadly divided into blunt and penetrative based on the mechanism of injury. Prompt diagnosis and recognition of iatrogenic GU injury are also paramount. A delay in diagnosis and treatment can have significant consequences – for example, abscess formation, fistulae and permanent renal impairment in the case of ureteric injury. Not all GU injuries require urgent surgery. Some can be managed with minimally invasive techniques (such as angiographic embolization) whilst others are managed entirely conservatively. The immediate management of these patients is geared towards haemodynamic stability. Haemodynamic shock that is resistant to the usual resuscitative measures often suggests ongoing bleeding and need for immediate intervention. The early management of most GU injuries with delayed presentation includes urinary diversion (through insertion of nephrostomy tube or suprapubic or urethral urinary catheter insertion) with delayed and definitive surgical reconstruction taking place at a later stage. Using the most up-to-date guidelines and published data we summarize the management of GU trauma by affected organ.