Urotrauma - Causes, Symptoms, Diagnosis, and Treatment

What Is Urotrauma?

Urotrauma is a commonly used term to describe the injury that occurs in the urinary tract or the reproductive tract. It can occur due to trauma, accidents, fights, and chemical injuries. Sometimes, people might have urotrauma due to falling from a great height. The organs most commonly affected due to urotrauma include the kidneys, uterus, urinary bladder, urethra, and other genital organs. Patients suffering from urotrauma find it difficult to urinate or reproduce. The specialist who treats urotrauma is known as a urologist. Before treating urologic injuries, including urotrauma, a urologist must know about open and minimally invasive surgical techniques.

How Does the Urinary Tract Function Normally?

The urinary tract commonly refers to the system of organs that work simultaneously to form, store, and remove urine from the body. Urine is nothing but the waste product of the blood as it comprises all the toxins filtered by the kidneys into the blood. Finally, this urine flows from the kidneys, through the ureters, into the urinary bladder, and exits the body through the urethra. In addition to cleaning the blood, the kidneys balance the body's chemical and electrolyte (sodium, potassium, calcium, and magnesium) levels. They synthesize hormones that regulate RBC (red blood cell) production and blood pressure and improve bone strength. The urinary bladder is a reservoir that stores urine and stimulates its removal from the body. The anatomy of the reproductive system is quite different in males and females. Hence, the urogenital system works hand in hand with the other body systems to carry out vital functions.

What Are the Causes of Urotrauma?

Urotrauma occurs due to the reasons mentioned below:

• Blunt trauma or wound occurs in the abdomen when a person gets hit by a vehicle or falls from a certain height.

• Deep wound due to a bullet.

• Straddle injuries to the genitals.

• Accidents.

• War injuries.

• Surgical injuries.

What Are the Signs and Symptoms of Urotrauma?

The signs and symptoms of urotrauma depend on where the patient has been injured. The symptoms are listed below:

• Pain in and around the pelvis.

• Pain in the back and the sides.

• Blood in the urine or thick discharge.

• Bruising in the sides or back.

• Difficulty in passing urine.

• Difficulty in emptying the urinary bladder.

• Difficulty in starting the urine stream.

• Dehydration.

• Bloating.

• Confusion.

• Irregular heart beating.

• Pale and cold skin.

• Coma or fainting.

How Is Urotrauma Diagnosed?

The doctor initiates the diagnosis by obtaining a thorough medical history of the patient, which includes the signs and symptoms of the condition, the medications, and other treatments undergone by the patient. The doctor also examines the patient's genitals for the following:

• Swelling in the urinary bladder or the abdomen.

• Deep wounds and bruises.

• Bleeding or shock.

• Pain or fracture in the rib or pelvic bones.

• Blood in the urine.

In addition to medical history and physical examination, the doctor recommends the following imaging tests:

1. X-ray - X-ray is an imaging test that allows the health care provider to have a perfect view of the internal organs, including the organs of the urogenital system. The patient is laid on a table with an X-ray machine positioned over him. The patient is expected to remain still during the procedure so that the X-ray can be taken properly. After the images are obtained, the doctor looks for the mark of injuries in the urogenital tract.

2. Retrograde Pyelogram - It is a contrast-induced procedure wherein the doctor inserts a cystoscope through the urethra into the ureters. Next, the doctor injects a dye or a radioactive contrast material with the help of this cystoscope and captures images with the help of a special camera. The movement of the contrast medium allows the doctor to help a better view of the urologic anomalies.

3. CT (Computed Tomography) Scan - This test is similar to an X-ray, the only difference being the image resolution. A CT scan helps the doctor visualize the urologic organs three-dimensionally. Therefore, it is commonly preferred over other imaging techniques to detect damage due to injuries. Both X-rays and CT scans help the doctor evaluate the following:

   1. Kidney trauma or renal trauma.

   2. Urethral trauma.

   3. Bladder trauma.

   4. Genital trauma.

How Is Urotrauma Treated?

The treatment of urotrauma depends on the type of injury. The treatment has been described below:

• Renal Trauma - Surgical intervention is required at the earliest if the patient suffers from kidney injury or the pooling of urine. This is because surgery can help improve the kidneys, and the body can work well with one kidney. The doctor might insert a tube known as a stent to drain the urine.

• Ureteral Trauma - The doctor might ask the patient to undergo a CT scan if the ureters become narrow or scarred due to the injury. A percutaneous nephrostomy might be done if the patient suffers from serious injuries. However, the doctor might insert a catheter or a stent for mild injuries.

• Bladder Trauma - Urinary bladder is a sac that holds the urine. The doctor might remove the bladder if it is severely damaged or recommends self-catheterization.

• Urethral Trauma - In addition to eliminating urine from the body, the main role of the urethra is to aid in ejaculation. However, the ejaculation gets disturbed in case of urethral damage. The urethra can get damaged due to injuries in the bones of the pelvis and straddle injuries. The doctor might recommend suprapubic tube insertion in case of emergencies and damage to the urethra due to pelvic bone fracture. This tube is usually placed in the urinary bladder by making a cut beneath the belly button. It can be used for three to six months until the healing is complete. Primary realignment can be done for males uncomfortable with suprapubic tube insertion. However, it is difficult to repair the urethra surgically.

• Genital Trauma - Surgery is usually done for patients with genital problems, including difficulty in passing urine, hematuria, and ruptured or infected testicles. The doctor might recommend testicle removal surgery in severe cases.

Conclusion

Urotrauma is not a condition but refers to the cluster of injuries that affect the reproductive tract and the urinary tract. Though these injuries are common, they affect the working of the urologic and reproductive organs. So, the patient must remain careful and consult the doctor at the earliest if any symptoms of urotrauma or other injuries are experienced.