GENITOURINARY INJURY

General Information

DEFINITION--Injury to a part of the genitourinary tract that may result from a variety of causes.

BODY PARTS INVOLVED--Kidney (organ that filters the blood and excretes waste products); bladder (the organ that stores urine); ureter (two tubes that carry urine from the kidneys to the bladder); urethra (the tube through which urine travels from the bladder to the outside); penis; scrotum.

SEX OR AGE MOST AFFECTED--Both sexes; all ages.

SIGNS & SYMPTOMS

• Severe abdominal pain.
• Shock (sweating; faintness; nausea; panting; rapid pulse; pale, cold, moist skin).
• Painful urination or inability to urinate.
• Pain or tenderness in the back, just below the ribs on the injured side.
• Fever (sometimes).
• Blood in the urine. If you have severe pain with large amounts of blood in your urine, one or both kidneys may be seriously injured.

CAUSES--Forceful or penetrating blow or wound to lower abdomen (gunshot or stab wounds, pelvic surgery, pelvic fracture, straddle injuries, kicks, penis amputation).

RISK INCREASES WITH

• Excess alcohol consumption.
• Hazardous occupations.
• Motor vehicle accidents.
• Sexually abused children.
• Medical treatments including surgery, shock waves, laser therapy, instrument use, radiation.
• Physical combat or physical violence.
• Penile rings.
• Excessive trauma during intercourse or other sexual activity.

HOW TO PREVENT

• Protect yourself from injury whenever possible.
• Buckle your automobile seat belt to minimize internal injury in case of accident.
• Don't drink and drive.
• Avoid alcohol or limit amount you consume.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory urine studies.
• X-rays of the urinary tract, intravenous urography, cystography (See Glossary for both).

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Hospitalization; emergency care.
• Surgery to repair any wounds, control bleeding and repair damage to the organs involved. A temporary catheter may be necessary for urinary drainage while the body heals.
• Injury to external male genitalia may require skin grafts.
• An amputated penis may be re-implanted using microsurgical techniques.

POSSIBLE COMPLICATIONS

• Internal bleeding.
• Urine leakage into the abdomen, causing abdominal inflammation or infection.
• Recurrent infections from scars in the urethra that narrow the urinary passage.
• Scarring and narrowing of the injured ureter.
• Atrophy of testes following a rupture injury.

PROBABLE OUTCOME--A genitourinary tract injury usually requires emergency treatment. Most cases heal with bed rest, time, supportive treatment or surgery.

How To Treat

GENERAL MEASURES---No specific instructions except those under other headings.

MEDICATION--Your doctor may prescribe:

• Antibiotics to prevent infection.
• Pain medicine as required.
• Anticholinergics for spasms.

ACTIVITY--Stay as active as your strength allows. Allow 1 month for recovery. Don't return to work or resume sexual relations until healing is complete.

DIET--

• No special diet.
• Drink 6 to 8 glasses of fluid daily.
• Don't drink alcohol.

Call Your Doctor If

• You have any symptoms of genitourinary injury.
• During or after treatment, you develop fever and chills.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.