What is Urotrauma?

What is Urotrauma?

Urotrauma is a word used for an injury to the urinary tract or reproductive organs. It could be from any traumatic event or impact. It could be from a fall, car or bicycle accident, chemical or weapon. Organs that may be affected by urotrauma include: the kidneys, ureters, bladder, urethra, and genitals.

Urotrauma may affect a person's sexual function, ability to reproduce or ability to urinate. Treatment is crucial.

How Does the Urinary Tract Normally Work?

The urinary tract is a system of organs that work together to make, store, and remove urine from the body. Urine is a waste product from blood. The kidneys clean the blood to create urine, which travels from the kidneys, down the ureters, to the bladder. From the bladder, urine moves down through the urethra, and out of the body.

The kidneys do more than just clean the blood. They also balance the acidity and chemicals in our bodies (sodium, potassium, calcium, phosphorous and others). They help control blood pressure, boost red blood cell production, and help make strong bones.

The bladder stores the urine made in the kidneys. It can hold urine for many hours and control its removal. The bladder connects to the urethra. This is the tube that connects the bladder to the genitals. The opening of the urethra is at the end of the penis in male, and in front of the vagina in females.

The male reproductive system   includes the penis, scrotum, and testicles (testes). They produce and maintain sperm and male hormones for the male reproductive cycle. The female reproductive organs   include the vagina, uterus (womb), ovaries, and fallopian tubes. These organs produce the egg and female sex hormones for the female reproductive cycle.

Updated December 2018

Symptoms

Symptoms of urotrauma depend on where you've been injured. You could have the following:

  • Pain in and around your pelvis
  • Pain in your back or side
  • Bruising in your back or side
  • Blood in urine or discharge
  • A hard time urinating.
  • A hard time emptying the bladder
  • A weak or no urine stream
  • Dehydration
  • Belly bloat

If there is bleeding inside of your body from an injury, it's an emergency. Watch-out for the following:

  • Confusion
  • Fast heart beat
  • Pale, cool skin
  • Cold sweat
  • Fainting/coma

Updated December 2018

Causes

Urotrauma may be caused in these ways:

  • Blunt trauma (such as a blow to the body)
  • Deep wounds (such as from a bullet or stab)
  • Falls or straddle injuries (to genitals)
  • Accidents (such as from car, bike, etc.)
  • Injury from war or fight of some kind
  • Injury from surgery

Updated December 2018

Diagnosis

Your doctor will start by asking you what happened. They will examine your genitals. They'll look for injury to the urethra or external organs and look for:

  • A swollen bladder or belly 
  • Deep bruises or wounds
  • Signs of bleeding or shock. (For example, a low blood pressure with a pelvic fracture) 
  • Painful or cracked pelvic or rib bones 
  • Blood in your urine

An x-ray or CT scan of the pelvic area is important. This is done with contrast (given by IV) to see the organs more clearly. This way your doctor can see an internal injury and target the injured organs.

Tests by diagnosis:

  • Renal (kidney) Trauma 
    CT Scan with contrast to see the kidneys and organs in the pelvis.
  • Ureteral Trauma 
    CT scan with contrast or retrograde pyelogram (x-ray with contrast) to see the ureters. Delayed imaging (CT urogram) is helpful for patients who are stable. A laparotomy lets the urologist see the ureter at the time of surgery. 
  • Bladder Trauma
    A retrograde cystogram is a detailed bladder x-ray, with contrast. It is used with a pelvic fracture, bladder injury, or blood in urine.
  • Urethral Trauma
    A retrograde urethrography is a a detailed urethral x-ray, with contrast. It is used for men who have bleeding or severe injury to the penis or pelvis. 
  • Genital Trauma
    A physical exam can see if the penis is swollen, cracked, bruised, or snaps with movement. 

Updated December 2018

Treatment

Treatment is done to repair an injury, control symptoms and prevent more problems. Often, surgery is needed. It's important to find an experienced urologist for your care.

Based on the injury, you may need emergency surgery. If emergency care is needed, it may include a blood transfusion, IV fluids, or a hospital stay.

For Renal (Kidney) Trauma

The time you spend in the hospital will depend on your injury and how quickly your kidneys can recover.

If the kidneys are bleeding, damaged, or if urine pools in the body, surgery is needed. Surgery can repair the kidney and hopefully save them. The body is remarkable, so if one kidney is no longer able to function, the other can do the job of two.

A CT scan is done after surgery to make sure recovery is going well. If urine is leaking or if there are problems like fever, infection, or pain, you will need more care. Your doctor will need to remove urine from your body. They can use a ureteral stent (a tube inserted into the ureters). Or they can use a tiny catheter through your back (percutaneous nephrostomy) for this job.

Dialysis may be needed to help replace kidney functions. This could be used for a short time, or as a long-term solution. Once the body is stable, you can recover at home.

Some patients get high blood pressure from a major kidney trauma. This may be treated with medicine.

Get more information about renal trauma.

Ureteral Trauma

The ureters are tubes made of muscle to move urine from the kidneys to the bladder. If one or both are damaged, you will need surgery to repair them.

Imaging can help your urologist decide the best treatment

If there is a limited tear to the ureters, stents or surgery can fix the tear. Ureteral stents are tubes placed in the ureter to guide urine flow in the bladder. If the injury is more serious, a percutaneous nephrostomy may be needed.This places a tiny catheter through your back to remove urine from the kidneys. In some cases, open surgery will be done to repair as much as possible. 

Some patients will need a period of recovery before surgery can be done to repair the ureter.

Bladder Trauma

The bladder is the sac that holds urine in the body until it is released out of the body. If the bladder is damaged or bleeding from an injury, surgery can help. Surgery can repair a tear or allow urine to flow better.
Often, a catheter is used to drain the bladder until it heals. If surgery repairs the bladder, the catheter will be removed.

Get more information about bladder trauma.

Urethral Trauma

The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. If it's damaged, your body will need help to urinate. If bones in the pelvis (the sacrum, coccyx, and hip bones) crack or break, it can damage the urethra. Trauma like this can also occur with straddle injuries or if an object pierces the sex organs.

For an emergency in which the pelvic bones are broken or the urethra is torn, a first step is to insert a suprapubic tube (SPT). This is a tube placed in the bladder through a cut below the belly button to drain urine. This can be used until the body can heal, or for longer. The SPT may be used for 3 to 6 months. After some time to heal from a pelvic fracture, it's easier to surgically connect torn edges of the urethra.

For some men, primary realignment (PR) is helpful if SPT is not. Surgery to repair the urethra in this way can be difficult. Your surgeon will want to limit scarring, erectile dysfunction (ED), and long-term incontinence.
Patients with urethral injuries will be watched carefully for at least one year after treatment. The hope is to avoid any scarring, incontinence, and for men, ED.

Learn more about urethral trauma.

Genital Trauma

Your care will be based on the injury to your genitals. The hope would be to repair sexual and urologic functions. The first step is to assess the problem and repair open wounds. If you don't have any open wounds, your doctor should check for internal problems.

If an ultrasound shows a penile fracture, surgery to repair the penis can help. If you are bleeding or can't pee, repair is crucial. Surgeons will want to work quickly to repair the penis. If the penis is cut off, the piece needs to be wrapped carefully in saline and placed on ice. Repair this way is only possible within hours of the injury.

For men, if the testicles are ruptured (broken) and cannot be saved, they may be removed (orchiectomy). The first goal would be to save the testicles. The sooner surgery can be done, the better.

For men or women, if the injury is from an infection or burns, the damaged skin will need to be removed and skin grafting may be needed.

Learn more information about penile trauma.

Updated December 2018

After Treatment

If you've had any type of urotrauma, your urologist will want to see you for follow-up visits. These visits are to make sure you don't have urine control problems or sexual dysfunction.

The most common problems after kidney treatment are urine leakage or bleeding. These may be treated by looking for the source (with a CT and possibly embolization). Embolization is a process to seal the tissue and stop bleeding where it's found. If this fails, more surgery may be needed.

If there is an infection, more care must be taken. Antibiotics may help. Sometimes a new surgery is needed to drain an abscess (pus forming).

If surgery was done on the urethra or bladder, the catheter in the bladder can be uncomfortable. It can cause pain or lead to blood in urine. If the catheter can be removed, these symptoms will go away. Tell your health care team if you have symptoms like these.

Scarring in the urethra is a long-term problem. The scars can partly block the flow of urine, causing a weak stream. Your urologist can often fix this by widening the scarred section. Sometimes this surgery needs to be done more than once to keep the urethra open.

Generally, recovery will take some time, and it may not be easy. If you have serious damage to your urinary system or genitals, you should ask to talk with a counselor you about your health. Counseling can help you manage stress from the trauma. This is very important if the injury leads to a loss sexual, urinary, and/or reproductive function.

Updated December 2018

More Information

Will the injury or the surgery cause problems with sex?

Severe injuries can harm the delicate nerves that run along the urethra. These nerves send the signal to the penis to become erect for sex. About 1 out of 2 men who have urethral injuries from pelvic fractures will have some type of erectile dysfunction once they heal. This may range in how serious they are. There are many ways to treat ED.

Will the injury or the surgery cause me to leak urine?

A small number of patients (2 to 5 out of 100) have problems with incontinence after trauma to the urethra. Incontinence is mainly due to nerve damage in the bladder outlet, not because of surgery.

Will I need more surgery after my first operation?

It depends on your injury. Many people can heal well after just one surgery. 

Updated December 2018