Trauma and Reconstructive Urology
Core concepts
Know renal, ureteral, bladder, urethral, and genital trauma evaluation and management. Renal trauma: CT with contrast for stable patients; most blunt injuries are managed nonoperatively. Ureteral injury: often iatrogenic; suspect with rising creatinine/fluid after pelvic surgery. Bladder injury: intraperitoneal (dome) needs surgical repair; extraperitoneal may be catheter drainage. Urethral injury: retrograde urethrogram; do not catheterize if suspected. Reconstructive topics include urethral stricture (buccal graft urethroplasty), ureteral stricture, and genitourinary fistula.
Traps
Do not place a urethral catheter when urethral injury is suspected (blood at meatus, high-riding prostate). Hematuria after blunt trauma with stable vitals is not an automatic indication for exploration. Intraperitoneal bladder rupture needs operative repair; extraperitoneal often does not.
Worked example
Pelvic fracture with blood at the meatus: obtain retrograde urethrogram; if urethral disruption, place suprapubic catheter and plan delayed repair.
Exam strategy
Stability dictates imaging vs immediate intervention; anatomic location dictates repair.