Skip to main content

Trauma & Emergencies

Genitourinary trauma and the urologic emergencies that share the trauma bay — bleeding, ischemia, sepsis, retention, and the iatrogenic injuries identified intraoperatively by non-urologic teams. Organized below by presentation: initial approach, organ-specific injury, non-traumatic emergencies, and operative adjuncts.

Initial Approach​

  • Trauma AssessmentATLS-aligned primary and secondary survey, hematuria thresholds, imaging triggers, and the role of the urologist in the trauma bay.
  • GU Injury OverviewIncidence by organ, mechanism-driven workup, AAST organ injury scale quick reference, and the principle that hematuria is an unreliable screen.

Organ-Specific Trauma​

  • Renal TraumaAAST grading, selective non-operative management, vascular injuries, angioembolization, and indications for renorrhaphy or nephrectomy.
  • Ureteral TraumaPenetrating-predominant mechanism, intraoperative recognition, location-based repair (UU, ureteroneocystostomy with psoas hitch / Boari, ileal interposition).
  • Bladder TraumaIntraperitoneal vs. extraperitoneal rupture, pelvic-fracture associations, CT cystography thresholds, and operative-vs-catheter management.
  • Pelvic Fracture Urethral Injury (PFUI)Suprapubic-cystostomy-first paradigm, delayed urethroplasty timing, distraction-defect anatomy, and the role of early endoscopic realignment.
  • Genital & Scrotal TraumaTesticular rupture and torsion-mimics, penetrating scrotal injuries, vulvar / perineal trauma, and Fournier's-associated soft-tissue loss.
  • Penile FractureTunica albuginea disruption, "popping" history with immediate detumescence, urethral-injury concomitance, and same-day operative repair.

Non-Traumatic Emergencies​

  • Necrotizing Fasciitis / Fournier's GangreneLRINEC scoring, broad-spectrum antibiotics, aggressive serial debridement, and reconstructive endpoints (STSG, scrotal flaps, perineal closure).
  • PriapismIschemic vs. non-ischemic differentiation, cavernosal blood gas, intracavernosal phenylephrine protocol, distal-shunt ladder, and the daily-PDE5i prevention paradox.
  • Testicular TorsionTime-to-detorsion outcomes, Doppler limitations, manual detorsion technique, and bilateral fixation at exploration.
  • Acute Urinary RetentionDecompression strategy, difficult-catheterization escalation algorithm (coudé → guidewire → flexible cystoscopy → SPC), POD recognition, and pre-TWOC alpha-blocker evidence.

Operative Adjuncts & Iatrogenic Injury​

  • On-Table (Single-Shot) IVP2 mL/kg / 10-min protocol, Morey 1999 SFGH landmark, false-negative limitations, and the decision to omit exploration of the contralateral kidney.
  • Intraoperative ConsultationThe urologist's operational guide to iatrogenic urinary-tract injury during non-urologic surgery — when to take the call, diagnostic maneuvers, organ-by-organ repair, and the procedures that generate GU injuries.