Injuries to the genitals are an unfortunate, and all too common occurrence in motorcycle accidents.
As a Sacramento Motorcycle accident attorney, I see these injuries frequently.
Genitourinary System Trauma
About 3-10 percent of all trauma patients have injuries involving the genitourinary tract. If the main trauma is the abdomen, 10-15 percent of the time there is trauma to the GU area. Urethral injuries make up 10 percent of GU injuries while the bladder makes up 40 percent.
Generally, genitourinary trauma is not fatal but it is associated with other fatal injuries, such as pelvic fractures. Urethral trauma usually occurs in men and is seen in the 15-25 year age group.
What is Genitourinary System Trauma?
The lower genitourinary tract includes the urinary bladder, urethra and the external genitalia. The upper urinary tract is made up of the kidney and ureters. Trauma can happen to any one of these areas.
Trauma to these areas includes laceration or crush injury to the kidneys, penetrating injury to the kidneys, laceration of the ureter, bladder rupture, urethral tear and damage to the external genitalia. Both blunt and penetrating trauma can be involved.
It is vitally important to identify blunt and penetrating injuries of the genitourinary tract as early as possible so as not to avoid secondary complications of urinary incontinence and dysfunction of sexual activity. Prompt identification of injury depends on a careful physical examination, noting bruising, blood in the urine, and swelling or deformity of the genitals.
If the injury is a shattering of the kidney or a laceration of the renal vasculature, the injury could be life-threatening. If not, these injuries are rarely fatal unless associated with other abdominal or pelvic injuries.
Eighty percent of injuries to the genitourinary tract occur secondary to blunt trauma. Most are secondary to motor vehicle accidents, falls from a great height and direct hits to the external genitalia or abdomen. Direct injuries to the female genitalia are most often related to fractures of the pelvis.
Other mechanisms of injury for genitourinary tract injuries include rape, penetrating injuries to the female genitalia or even consensual sex. If an isolated blunt trauma injury occurs just to the vulvar area, there should be screening for interpersonal violence. In men, testicular injuries result from blunt force injury about 85 percent of the time. Injuries from this include rupture of the testicle, hematoma, torsion and displacement of the testes. Penis fractures are uncommon but result from an acute rupture of the tunica albuginea and a secondary urethral injury about 20 percent of the time.
Urethral injuries happen in only about 5 percent of women get a urethral injury along with their pelvic fracture, while men get urethral injuries 25 percent of the time with pelvic injury. Blunt trauma is the most common cause of bladder injury in both males and females.
Bladder trauma is almost always blunt trauma. Eighty-five percent are associated with a fracture of the pelvis. The rest are due to penetrating injuries and those blunt traumas not associated with a pelvic injury such as a full bladder blowout.
There can be posterior urethral injuries that are most commonly due to pelvic fractures and injuries to the anterior urethra, which are secondary to straddle injuries like injuries on bicycles and injuries on skateboards.
Injuries to the external genitalia of the male as an isolated event can be due to sexual-pleasure enhancing devices, continence-enhancing devices, blunt trauma or penetrating trauma.
Signs and Symptoms of Genitourinary Trauma
Depending on the site and nature of the injury, there can be many different signs and symptoms of genitourinary trauma:
• Flank pain in kidney trauma
• Blood in the urine
• Inability to void in bladder rupture
• Deformity of the penis
• Deformity of the scrotum
• Swelling or bruising of the scrotum
• Vaginal bleeding
• Vulvar bruising or swelling
• Pelvic pain
Causes of Genitourinary Trauma
Genitourinary trauma is divided into blunt trauma and penetrating trauma. The causes of these injuries include:
• Motor vehicle injuries
• Fall from a great height
• Motorcycle accident
• ATV accident
• Knife wound
• Sex-enhancing devices
• Bicycle injury to the vulva or scrotum
• Head-on collision with a full bladder
Diagnosis of Urinary Tract Trauma
If there is any possibility of a urethral rupture, consult with a urologist before inserting a urinary catheter. Check for blood in the urine by whatever means possible, which can mean trauma anywhere from the urethra on up to the kidneys. Palpate the flank area for evidence of pain and inspect for swelling and bruising. Evaluate the external genitalia for evidence of deformity, swelling, bleeding or bruising.
A plain film x-ray may be able to show a deformity of the kidney, although a CT or MRI scan of the abdomen would be better tests to outline the structure of the kidneys and to detect areas where urine is pooling outside of the genitourinary tract.
Treatment of Genitourinary Tract Injuries
Genitourinary tract injuries can be complicated and the treatment can be difficult. There is short term treatment followed by definitive treatment.
Short term management includes:
• Placing a urethral catheter carefully.
• Using a suprapubic catheter inserted directly into the bladder to drain urine if the urethra is not patent.
• Nephrostomy tube placement involves putting a tube directly into the kidney to drain the kidneys directly.
• Ureteral stent placement to connect the bladder to the kidney if the ureter is crushed or lacerated.
In kidney injuries, the treatment depends on the presence of other injuries and the severity of the kidney injury. Eighty five percent of injuries to the kidneys are minor blunt trauma injuries that can be treated with watchful waiting. Rest and good hydration will minimize the bleeding and eventually the injury will heal.
Penetrating injuries to the kidney often require surgery due to severe bleeding. The bowel and liver may be involved as well. Surgery can be used as an exploratory surgery, fixing different aspects of the injury. If the injury is too severe, the kidney may need to be removed.
Ureteral injuries are uncommon and are often due to a gunshot wound or to an iatrogenic injury. If the urethra is completely disrupted, surgery is required to sew the ends of the ureter together.
In partial injuries, a ureteral stent can be placed to keep urine flowing to the bladder from the kidneys. Some ureteral stents are meant to be permanent in order to bypass a blockage.
Bladder injuries can be blunt trauma or penetrating trauma. In a contusion injury, the bladder is just bruised and does not rupture. These can be managed with simple ureteral catheterization. When the urine is cleared, the catheter can be taken out. In cases of extraperitoneal rupture, a catheter alone will be all that is necessary, with the expectation that the patient heals within about ten days. In an intraperitoneal rupture, surgery is needed to prevent the urine from leaking into the abdomen. The tear is simply closed shut in surgery. In penetrating injuries, holes in the bladder are sewn together and surrounding organs are repaired at the same time. A catheter is placed in the bladder until there is no blood in the bladder.
Urethral injuries can be hard to heal and usually come up in the case of men. Sometimes surgery is done on an emergent basis after a catheter is placed in the bladder to allow for proper bladder drainage.
The penis can be endangered through penetrating trauma or through things like penile fractures. Penile fractures can happen in sexual intercourse. These injuries are surgically repaired. Some men are into using penile rings at the base of the penis with the possibility of a constricting injury of the penis and urethra. It can cause gangrene of the penis which needs repair by using skin grafting.
Testicular injuries are usually blunt force traumatic injuries. A testicular ultrasound can detect
I am a member of Million Dollar Forum, an association of national personal injury lawyers who have multiple Million Dollar Verdicts and settlements.