Urological trauma.

Abstract

Major urological trauma is life threatening and frequently associated with trauma to other organs. A conservative approach to lesser degrees of damage to the kidney is fully justified whilst a shattered kidney or a pedicle injury calls for surgical exploration. Renal injuries between these two extremes require careful assessment and clinical judgement to decide the best management. An intravenous urogram remains the mainstay of investigation but computed tomography, ultrasound and arteriography can be useful in some circumstances. The management of urethral trauma remains controversial and depends largely on the assessment of whether the posterior urethra is partially or completely ruptured. There remain two schools of thought concerning early or late intervention but all are agreed that suprapubic diversion is essential and that a urethral catheter should not be passed blindly in the initial stages. A ruptured bladder should always be repaired and early intervention is recommended for ureteric injuries. Severe trauma to the testis is best managed operatively to reduce the morbidity.