Emergency Management of Renal and Genitourinary Trauma: Best Practices Update - EXTRA Supplement (Trauma CME)

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Delivery Method:	Online
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Publication Date: March 2026 (Volume 28, Supplement 3)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 03/23/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional approval.

Authors

Abstract

For polytrauma patients who may have life-threatening injuries, renal and genitourinary trauma may be overlooked initially, but a delayed or missed diagnosis of these injuries may result in potentially preventable complications. This review provides a best-practice approach to the diagnosis and management of renal and genitourinary injuries, with an emphasis on the systematic approach needed to identify subtle injuries and avoid long-term sequelae such as hypertension, incontinence, urethral stricture, erectile dysfunction, chronic kidney disease, and nephrectomy.

Case Presentations

A 23-year-old man presents to the ED and tells you it hurts “everywhere”…

• He appears to be intoxicated and was involved in an altercation. He has bruises and red marks that look like shoe prints over his abdomen, flanks, and chest.
• On his right flank, he has a 1- by 2-cm wound he said was made by a screwdriver.
• His temperature is 36.5°C; heart rate, 135 beats/min; blood pressure, 85/49 mm Hg; respiratory rate, 24 breaths/min; and oxygen saturation, 97%.
• You consider whether a urinalysis will help in working up this patient. What kind of special imaging is he going to need?

A 46-year-old woman who was in a motor vehicle crash presents by EMS to the ED…

• She appears to be intoxicated, and EMS tells you that she was the unrestrained and ejected passenger in a high-speed, rollover, single-car crash.
• Her temperature is 38.3°C; heart rate, 107 beats/min; blood pressure, 86/68 mm Hg; respiratory rate, 18 breaths/min; and oxygen saturation, 94%.
• EMS has placed a pelvic binder, and a tense, swollen abdomen extends above it.
• During the resuscitation, you notice she is bleeding briskly from her vagina.
• Should you place a Foley catheter? Do you need to page urology and trauma as well?

A 54-year-old man who was in a high-speed motorcycle crash presents by EMS to the ED…

• He is screaming in pain and has an obvious chest wall deformity, with crepitus.
• He has a massive hematoma to his perineum and scrotum, a testicle that appears dislocated and free from the scrotum, and a deformity to his penile shaft. There is gross blood at the urethral meatus.
• His temperature is 36.1°C; heart rate, 144 beats/min; blood pressure, 103/81 mm Hg; respiratory rate, 31 breaths/min; and oxygen saturation, 88%.
• How do you begin assessing this patient’s genitourinary trauma? Should you place a suprapubic catheter?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.