The document discusses various types of genitourinary trauma including renal trauma, bladder injuries, urethral injuries, testicular injuries, and penile fracture. Renal trauma is classified into 5 grades based on the severity of injury and most blunt renal traumas are managed conservatively. Bladder injuries are diagnosed using cystograms and managed either with catheter drainage or operative repair depending on the injury. Urethral injuries can involve the anterior or posterior urethra and are treated with suprapubic cystostomy or urethroplasty. Testicular injuries require early exploration and surgery if ruptured. Penile fractures require prompt surgical repair to prevent complications.

1. Urology Department
Under-graduate courses
Genito-urinary Trauma
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

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3. Renal trauma
Epidemiology
• Most common among genito-urinary trauma
• 1-5 % of all trauma
Mechanism:
• Blunt trauma (motor car accidents, assaults,
falls, contact sports)
• Penetrating trauma (stabs, high velocity
gunshots)
• Blast effect (low velocity gunshots)
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By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

4. Renal trauma- Classification
– Grade I : Contusion or non expanding subcapsular
hematoma (no laceration)
– Grade II : Non expanding peri-renal hematoma or cortical
laceration < 1 cm
– Grade III : Cortical laceration > 1 cm
– Grade IV : Laceration through cortico-medullary junction into
collecting system or segmental artery or vein injury with
contained hematoma
– Grade V: Shattered kidney or renal pedicle injury or avulsion
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By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

5. Renal trauma- Evaluation
History of trauma: direct blow to the flank, rapid
deceleration, type and size of weapon
Signs indicating an underlying renal injury (fractured
ribs, flank ecchymoses or abrasions).
Physical examination and assessment of
hemodynamic instability (heart rate, blood pressure,
respiratory rate, and mental state).
Urinalysis for detection of microscopic hematuria.
(degree of hematuria does not correlate with of degree
renal injury)
Imaging CT with contrast or on- table IVU (single shot).
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By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

6. Renal trauma- Management
1. Blunt injuries:
 most of them are managed conservatively (90%).
 Life threatening haemodynamic instability or grade
5 injuries are absolute indication for surgical
exploration (10%).
2. Sharp injuries are managed by surgical
exploration.
• Most explorations ultimately lead to a nephrectomy.
• The presence of a normal functioning kidney on the
contralateral side must be established.
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By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

7. Renal trauma- Complications
Early complications Late complications
– Bleeding – Hydronephrosis
– Infection – Calculus formation
– Abscess formation – Chronic pyelonephritis
– Urinary fistula – Hypertension (Page
– Urinoma kidney)
– Arteriovenous fistula
– Pseudoaneurysm
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By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

8. Bladder injuries
• Presentation: by Gross hematuria (82% of
patients), along with lower abdominal tenderness.
• Diagnosis: by cystogram
Intraperitoneal injury: Extraperitoneal injury:
contrast material outlines loops Dense, flame-shaped collection
of bowel. of contrast material in the pelvis
©
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

9. Bladder injuries- Management
• Blunt extraperitoneal rupture managed by
catheter drainage. Most ruptures heal within 10
days.
• Penetrating or intraperitoneal injuries should
be managed by immediate operative repair.
©
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

10. Urethral injuries
• Male urethra is divided by urogenital diaphragm
into 2 segments:
1. Anterior (bulbar & penile)
2. Posterior (membranous & prostatic)
©
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

11. Urethral injuries
• Posterior urethral injuries mostly result from pelvic
fractures.
• The injury can range from a stretch or contusion
injury to complete disruption.
• Anterior urethral injuries occur after road traffic
accidents, falls, or straddle type injuries (blunt
blow to the perineum).
• Iatrogenic injury to the urethra secondary to
endoscopic trauma and instrumentation is the
most common cause of urethral stricture.
©
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

12. Urethral injuries- Diagnosis
 Blood at urethral meatus
 Ascending urethrography before trial of catheterization
©
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

13. Urethral injuries- Management
• Anterior urethral injury:
– Initial management by suprapubic cystotomy.
– Later, stricture formation can be managed with
endoscopy (for short strictures) or
urethroplasty (for longer strictures).
• Posterior urethral injury:
– a suprapubic catheter is placed and delayed
repair (urethroplasty) is done after 3 months.
©
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

14. Testicular injuries
Classification:
• Blunt: kicks, straddle injuries
(compression fo the testicle
against lower border of pubic
bone).
• Penetrating Testicular rupture
Significant testicular injuries present with a swollen
tender scrotum
©
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

15. Testicular injuries management
• Conservative treatment: in the absence of
significant scrotal swelling.
• Early scrotal exploration is needed in cases of
testicular rupture (tunica albuginea tear).
1. Debridement of non-viable tissue is undertaken,
with an attempt to preserve as much testicular
tissue as possible.
2. orchidectomy is performed when the testicle
cannot be conserved.
©
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

16. Penile fracture
Aetiology
• Extreme angulation of erect penis during intercourse is
the most common cause.
• Classic history is diagnostic
• Tear in the tunica may be palpated
Classic presentation
– Severe pain
– Rapid detumescence
– Penile swelling and echimosis as a result of rupture of the
tunica albuginia that covers the corpora cavernosa.
Management
• Early repair of penile fracture maintains erectile function
and prevents late onset penile curvature.
©
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

17. Thank You
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS