Falls, assaults, motor vehicle crashes, and sports injuries are the most common mechanisms for blunt GU injuries, whereas gunshot wounds and stab wounds are the most common causes for penetrating injuries.1 Seatbelt use and air bag deployment have increasingly been associated with decreased rates of nephrectomy in renal trauma patients.2 Epidemiologic data are different for civilian populations when compared to military personnel, whose exposure to explosive devices increases the risk of external genitalia trauma.3 GU organs are injured in approximately 5% of traumas.4 Isolated GU injuries are uncommon due to their relatively protected anatomical position. Significant damage is usually associated with other injuries. Due to lack of periadipose tissue and relatively large kidneys, children are anatomically more susceptible to GU injury than the general population.5 Appropriate management will minimize or prevent complications such as renal function impairment, urinary incontinence, and sexual dysfunction.
Obtain a detailed history to determine the time and mechanism of injury and the magnitude of forces involved. In motor vehicle crashes, seat location, use of restraints, vehicle speed, and crash details provide information about forces applied to the victim. Sudden deceleration can cause major vascular disruption and parenchymal damage to the kidneys and bladder, even in the absence of symptoms and physical findings.
Determine patient symptomatology whenever possible. An inability to urinate may be due to an empty bladder or inability to void because of pain, but can also result from bladder perforation, urethral injury, or spinal cord injury. Presence of preexisting genitorenal dysfunction may predispose to worse outcomes and should prompt consideration of more extensive workup.6
Inspect the perineum during the secondary survey. Blood on the underwear or pants is an important finding and may suggest genital trauma. Inspect the folds of the buttocks for ecchymoses, abrasions, or lacerations, which may be related to an open pelvic fracture. Do not deeply probe perineal injuries because probing could disrupt a clot.
Rectal examination identifies sphincter tone, position of the prostate gland, and presence of blood. If the prostate is “missing” or riding high or feels boggy, assume disruption of the membranous urethra until proven otherwise. In males, examine the scrotum for ecchymoses, laceration, and testicular disruption. Palpate and inspect the penis for ecchymoses, deformity, and blood at the meatus. In females, examine the vaginal introitus for lacerations and hematomas, which can accompany pelvic fracture. Perform a speculum examination when vaginal bleeding or hematoma is present to exclude vaginal laceration. Complications of missed vaginal injuries include infection, fistula formation, and hemorrhage.
Renal injury is present in up to 10% of patients with abdominal trauma.4,5 Because of the protected position of the kidneys, ...