Overview
Traumatic injuries that affect the urinary tract and its organs or the male genitalia can be treated very effectively by our reconstructive urologists. If you have experienced a traumatic accident or injury that needs to be taken care of, contact our reconstructive urology clinic for an immediate consultation.
What Organs Can Be Injured with Trauma?
The genito-urinary system encompasses many organs:
- Kidneys
- Ureters
- Bladder
- Urethra
- Testis
- External genitalia
These organs can be damaged along with other internal organs when patients have suffer massive multi-systems trauma from incidents like auto accidents, industrial accidents or when patients are victims of gunshot wounds or other violent crimes.
The external genitalia and the urethra (urinary channel from the bladder) can also be damaged with site-specific trauma that can be fairly minor. Some genito-urinary injuries are managed with immediate surgery to save the life of the patients that have been the victims of trauma; other injuries are managed with observation and delayed surgery if needed in the future after healing has had time to occur.
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Kidney Injury
In areas other than urban centers, most kidney injuries occur from a blunt force trauma, such as a high-speed auto accident. In these injuries other organ injuries and broken bones are very common. Most of these kidney injuries can be managed with careful observation.
On occasion an injury is so severe that patients require immediate life saving operations to either repair or remove the kidney. Occasional patients need other procedures like insertion of drains around the kidney or a temporary drainage tube (urinary stent) to help the kidney heal. In rare cases the kidney may need to be removed in the future because of chronic infection or loss of function. Usually the loss of one kidney does not increase the chance of kidney failure in the future.
Urethral Trauma
The urethra is usually injured in one of two ways:
- Pelvic fracture - The sheering forces of the pelvic fracture tear the urethra into two somewhere around the location of the prostate as the urethra travels towards the bladder. This is called a posterior urethral disruption. Often a procedure is done to try to realign the urethra so that it can heal together over a catheter. Other times the damage is too severe and a catheter is left in the bladder and a plan is made for subsequent surgery in the future. Scarring occurs in the area where the urethra was ripped apart and usually a surgery needs to be done where this scar is removed and the healthy urethra is brought to the tip of the prostate and sewn to the other uninjured portion of the urethra. This surgery is called a posterior urethroplasty.
- Straddle injury - In this injury a male patient falls forcefully with the legs apart on something hard. Some examples of this are falling upon the crossbar of a bicycle, a railing, or being bucked onto the horn of a saddle. In this injury, the urethra is squeezed against the underside of the pubic bone and forcefully divided in two. Usually patients have a lot of bleeding from the penis and a large bruise forms in the groin and perineum (the area between the anus and the scrotum). The initial management of these injuries involves a similar strategy to pelvic fracture injuries. A catheter can be placed across the gap in hopes that the urethra will heal together or a catheter can be placed through the abdomen into the bladder (suprapubic tube) and a surgery can be done some time later to fix the scarring that develops.
Treatment
Most of these traumatic injuries to the urethra can be fixed about three to six months after they occur. We know that fixing the injuries immediately after they occur increases the chance of recurrent scarring and also can harm erections. This is the reason for the delay for three to six months.
During this time patients are treated with a suprapubic catheter, which is changed every four to six weeks in our clinic. In some cases it is important to wait for complete healing of pelvic fractures and the pelvis to stabilize before surgery is performed.
Bladder Trauma
The bladder can be injured either during a pelvic fracture or secondary to a forceful blow to the abdomen when the bladder is full. This very commonly can occur due to a seatbelt or a steering wheal injury during a automobile accident. Bladder injuries that open into the abdomen are closed immediately, those that spill urine into the tissues surrounding the bladder but do not communicated with the abdominal cavity can be treated with a urinary catheter for approximately two weeks.
Chronic problems with urinary leakage outside of the bladder into the pelvic area or the skin can occasionally occur after severe injuries. In these cases patients may need reconstructive surgery.
Penile Trauma
One of the main causes of penile trauma is intercourse. When an injury occurs during intercourse the penile trauma is called a penile fracture. The mechanism of this injury is the erect penis comes out of the vagina and forcefully impacts the pubic bone of the partner. This force buckles the erect penis and a tear occurs in the tough outer lining (tunica albuginea) of the natural piston of the penis (corporal body). The penis rapidly loses its rigidity and a large bruise develops from the base of the penis to the head of the penis.
A moderate amount of pain is associated with this. Occasionally the tear is so severe that the urethra (urinary channel) is also injured. Penile fractures should be repaired as soon as is practical after they occur. If they are not repaired, most urologists feel there is an increased likelihood of erectile problems and scarring in the future.
Treatment
To repair a penile fracture, an incision is made over the area and strong stitches are used to re-approximate the torn portions of the tough outer lining of the penile shaft. The urethra is repaired at the same time.
Testicular Trauma
Trauma to the testis can cause the testicle to rupture. The types of trauma that can cause these injuries include:
- Sports related accidents,
- Penetrating injuries like a gunshot wound, or
- Any forceful blow to the testicle.
The testicle contains seminiferous tubules, which are responsible for the production of testosterone and sperm. Prompt repair of these ruptures can preserve the function of the testicle and minimize pain and scarring from the injuries. This is done through a small incision within the scrotal wall.
Occasionally testicles are not salvageable with surgery and must be removed at the time of surgery. It is infrequent that this is the case, usually some testicular function can be preserved
Ureteral Injuries
The ureter runs from the kidney to the bladder and transports urine from the kidney to the bladder. The most common cause of injury to the ureter is during some type of surgery. The ureter can be injured particularly during hysterectomy or other gynecologic procedures. This is because of the proximity of the ureter to the uterus and gynecologic structures of the pelvis. The management of these injuries usually involves surgery to reconnect the ureter to the bladder. There are a variety of ways of accomplishing this depending upon the length of the scarring or ureteral injury.