Genitourinary trauma

(Redirected from GU Trauma)


(1) Human urinary system: (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra.
Additional structures: (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.
Renal anatomy.
Perinephric space with exaggerated pararenal space to show retroperitoneal structures. Perinephric bridging septa are seen between the left kidney and the adjacent renal fascia.
  • Typically divided into:
    • Upper tract injuries (kidney + ureter)
    • Lower tract Injuries (bladder + urethra + genitalia)

Clinical Features

Upper tract injury

  • Majority of blunt trauma injuries present with hematuria
  • Renal pedicle injuries and penetrating injuries to ureter may not cause hematuria
  • Renal injuries are associated with flank hematoma, lower rib fracture, penetrating wounds to flanks

Lower tract injury

Differential Diagnosis

Genitourinary Trauma

Abdominal Trauma



  • Who to image?
    • Penetrating Trauma
      • Any degree of hematuria
    • Blunt Trauma
      • Gross hematuria
      • Hypotension and any degree of hematuria
      • Child with >50rbc/HPF
      • High index of suspicion for renal trauma
        • Deceleration injuries even with no hematuria
        • Multiple trauma patient


  • CT with IV contrast is the gold standard in assessing renal and GU trauma
    • More sensitive and specific than IVP, ultrasound, or angiography
    • However, can miss significant injuries to the renal pelvis, collecting system and ureter given CT generally obtained before contrast is excreted in the urine.
    • If initial CT shows high grade renal injury (grade IV of V), UPJ injury, or concern for ureteral injury, should obtain additional 10 minute delayed CT[1][2]
    • Exception to using IVP over CT is perioperatively in unstable patients requiring immediate operation for other injuries
    • Note, CT A/P with IV contrast NOT sensitive enough for bladder rupture, requires CT cystography



See Also

External Links


  1. Morey AF, Brandes S, Dugi DD 3rd, et al. Urotrauma: AUA guideline. J Urol. 2014;192(2):327-335.
  2. 33.* Holevar M, DiGiacomo C, Ebert J, et al. Practice management guidelines for the evaluation of genitourinary trauma.