Penetrating high-velocity genitourinary injuries. Part II: Ureteral, lower tract, and genital wounds.

Penetrating ureteral wounds appear to occur at a constant low rate and demand internal splinting without ureterotomy drainage in the multiple-injured patient. Concomitant upper urinary tract and colonic or pancreatic injury absolutely requires the use of nephrostomy drainage. Most prostatic or prostatomembranous rupture can be approached retropubically, or if extensive tissue damage and uncontrollable hemorrhage are present, by transpubic methods. Intravesical fixation of the prostatomembranous rupture provides the best anchorage and approximation. Rectoprostatic-bladder wounds should be approached suprapubically and may be drained transcoccygeally also. Section of the obturator nerve may provide postoperative pain relief in severe pubic ramus fractures. Small high-velocity entrance wounds in the external genitalia warrant exploration because of great internal disruption. The skin of the external genitalia should be closed primarily.