ASSOCIATED GENITOURINARY (GU) INJURIES

DCBI is associated with perineal wounds and injuries to genitalia. Bladder and ureter injuries are less common, but if a large perineal wound is present, appropriate studies should be undertaken to assess for potential injury to these GU organs. Perineal, genital, and urethral wounds should be addressed with urinary management and basic wound care. Since the initial focus on the index operation is hemorrhage control, debridement and irrigation of wounds, definitive management of GU wounds should be staged. If scrotal skin is missing, the testicles should be wrapped in Adaptec or Vaseline gauze to prevent the tunica from desiccating. In the case of a penile or urethral injury, a foley catheter should be attempted and tissue temporarily closed over the urethra. A penile or distal urethral injury is not a reason for an SP tube if a urinary catheter can be placed. Adjuncts to help place a catheter include ureteroscope, wires, and fluoroscopy, but should be performed at an interval operation once the casualty is stabilized. A retrograde urethrogram should be performed if a urethral injury is suspected. In the case of urethral disruption and inability to place a catheter over a wire, a suprapubic catheter (tube) should be placed either percutaneously or open. If available, seek the consult or assistance of a urologist.

Refer to JTS Genitourinary Injury Trauma Management CPG for further guidance.23