Open and penetrating urogenital injuries

Definition

Penetrating urogenital injuries (gunshot, knife, and puncture wounds) require a multidisciplinary approach.

Clinical assessment

• Wounding object, entry and exit wounds.
• Bleeding, hematuria, urethral bleeding.
• Signs of injury to adjacent organs (bowel, blood vessels).

Diagnosis

• Contrast-enhanced CT (angiography, urography).
• Retrograde urethrography for urethral injury.
• Wound examination under general anesthesia.

Emergency management

• ABCDE → hemorrhage control → stabilization.
• Renal injury: embolization or nephrectomy as indicated.
• Ureteral injury: stenting or reconstruction.
• Bladder injury: repair + drainage.
• Urethral injury: cystostomy + delayed reconstruction.
• Broad-spectrum antibiotics, tetanus vaccination.

Algorithm