Genitourinary tract injury

Lore & Background

The kidney is the most frequently injured organ in the genitourinary tract, with blunt force accounting for 80–85% of injuries. Major decelerations can cause vascular injuries near the kidney's hilum, while penetrating injuries may result from gunshots, knife wounds, or fractured ribs. Pelvic fractures frequently damage the urethra and bladder, with 90% of bladder injuries involving a concurrent pelvic fracture, where bone fragments perforate the bladder either extraperitoneally or intraperitoneally.

Reader's Guide

Diagnosis of genitourinary tract injury relies on clinical signs such as hematuria (blood in urine) after trauma, lower rib fractures suggesting renal injury, and pelvic fractures indicating bladder or urethral injury. Blood at the urethral meatus precludes Foley catheter insertion to avoid complications like infection or conversion of a partial urethral transection to a complete one. Imaging includes abdominal CT with contrast for renal injuries, retrograde urethrography for urethral injuries, and retrograde cystography for bladder perforations. Management of urethral injuries depends on location: posterior urethra injuries (e.g., separation of the membranous urethra from the prostate) require suprapubic cystostomy and delayed reconstruction, while anterior urethra injuries are managed based on extent. Bladder perforations are closed with absorbable sutures, and a suprapubic cystostomy is left in place for three months for complete disruptions or three weeks for incomplete ones.

Did You Know?

• Blunt force is involved in 80–85% of kidney injuries.
• In 90% of bladder injuries, there is a concurrent pelvic fracture.
• Blood at the urethral meatus precludes insertion of a Foley catheter.