Urogenital trauma

Abstract Urogenital trauma tends to be blunt and age-specific, and can be isolated or part of multi-trauma. Most blunt renal trauma is associated with other injuries, but the majority of cases can be managed non-operatively. Embolization or surgery may be required for ongoing major bleeding from the renal artery. Salvage of an avascular kidney is unlikely. Disruption of the pelvi-ureteric junction can be managed by early surgical repair or urinary diversion and late repair. Ureteric injury in children is rare, and usually iatrogenic, sustained during laparoscopic procedures. The abdominal position of the bladder in young children increases its vulnerability to trauma. Bladder rupture can be intra- or extra-peritoneal. Intra-peritoneal rupture usually requires surgical repair. Blunt trauma with pelvic fractures is more likely to injure the membranous urethra, whereas straddle injuries tend to cause injury to the bulbar urethra. Urethral injury presents with blood at the urethral meatus, pain and dysuria, haematuria, perineal extravasation, or acute urinary retention, depending on the degree of tear and its level. Retrograde urethrography and direct urethroscopy help to delineate the injury. Penile injuries include zippers, dog bites, scalds, toilet seat crush injuries, iatrogenic injury during circumcision, and hair-thread tourniquet syndrome. Significant trauma to the testes is rare. Assessment of suspected vaginal injury often requires examination under general anaesthesia.