Urologic injuries.

We have reviewed our experience in 311 cases of urologic trauma seen at Detroit General Hospital. A properly organized emergency surgery team is necessary to handle these types of injures effectively. We feel that, whenever possible, evaluation of any patient suspected of genitourinary trauma should be accomplished by a urologist before the patient enters the operating room. We approach renal injuries with a conservative viewpoint, trying to preserve as much renal tissue as possible, yet realizing that at time an aggressive approach to renal injuries is necessary to accomplish this and to save the patient's life. The injuries of the renal pelvis and ureter should be treated by debridement and a water-tight anastomosis with a fine absorbable material. It is our impression that patients suffering from gunshot wounds, because an ideal anastomosis is not possible, do better with a stented anastomosis. Ruptures of the bladder are simple to repair and attention is focused on the diagnosis and exploration of associated ureteral injuries. The prostatomembranous disruptions are without question one of the most difficult injuries in urology. Although we attempt to stent the urethra in order to align the ends, we condemn a vigorous attempt with interlocking sounds or other instruments since they may lead to iatrogenic injuries of the urogenital diaphragm. In these cases suprapubic cystostomy drainage and secondary repair is indicated. Our results with a group of patients with injuries of the anterior urethra showed that the overwhelming majority of these patients did well with a suprapubic cystostomy and drainage with no immediate repair.