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Current Management of Urinary Tract Injuries

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Operative Techniques and Recent Advances in Acute Care and Emergency Surgery

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Abstract

Injury to the urinary tract and scrotum can be due to blunt or penetrating trauma. In many circumstances, injuries to the urogenital tract occur in the setting of a polytrauma patient. Therefore, these patients require a multidisciplinary approach. The majority of urogenital injuries are not directly life-threatening and have thus a low priority in the trauma management of a polytrauma patient. Nevertheless, adequate early diagnosis and management are warranted as inadequate diagnosis and treatment can provoke severe long-term complications and invalidity. The standard diagnostic modality of renal (and ureteral) injury is multiphase contrast-enhanced CT if the condition of the patient allows for this. CT cystography is preferred to diagnose bladder injury, whereas retrograde urethrography is the standard for urethral injury. Except in case of hemodynamic instability, renal injury is treated conservatively, if needed, with adjuvant angioembolization. Early recognition of ureteral trauma is crucial as the ureteral injury is usually less complex to repair at that moment. Intraperitoneal bladder injuries need exploration with surgical repair and urinary diversion until bladder healing. Uncomplicated extraperitoneal bladder injuries can be managed by urinary diversion only, until spontaneous bladder healing is achieved. Placement of a suprapubic catheter under echographic or direct vision is always a good solution in the initial management of urethral injury. Early exploration and repair of a testicular rupture are required to salvage the testicle.

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Author information

Authors and Affiliations

  1. Department of Urology, Ghent University Hospital, Ghent, Belgium

    Nicolaas Lumen

  2. Department of Urology, Gronau St. Antonius Hospital, Gronau, Germany

    Florence Desmidt

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  1. Nicolaas Lumen
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  2. Florence Desmidt
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Correspondence to Nicolaas Lumen .

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Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Milano, Italy

    Paolo Aseni

  2. School of Medicine, University of Milano-Bicocca, Niguarda Hospital, Milan, Milano, Italy

    Luciano De Carlis

  3. Department of Cardiac Surgery, IRCCS MultiMedica, Milan, Milano, Italy

    Alessandro Mazzola

  4. Department of Cardiac Surgery, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

    Antonino M. Grande

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Lumen, N., Desmidt, F. (2019). Current Management of Urinary Tract Injuries. In: Aseni, P., De Carlis, L., Mazzola, A., Grande, A.M. (eds) Operative Techniques and Recent Advances in Acute Care and Emergency Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-95114-0_25

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  • DOI: https://doi.org/10.1007/978-3-319-95114-0_25

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