The approach to these injuries has been described in detail above, as they will be mainly approached in the emergency room.
Briefly, these injuries are usually not life-threatening by themselves but carry a high potential for late morbidity and tend to be associated with other significant abdominal and pelvic injuries. When discovered intra-operatively, intraperitoneal bladder tears should be addressed by rapid repair with running absorbable sutures and maximal bladder drainage by suprapubic cystostomy, urethral catheter, or both. In extreme situations when primary closure of the bladder cannot be obtained (due to lack of viable tissue), single-J ureteral catheters can be inserted and exteriorized to obtain temporary urinary drainage. Extraperitoneal tears should be treated by drainage of the bladder. Time-consuming maneuvers such as exploration of the deep pelvis and the bladder should be avoided.
High-grade urethral injuries are generally treated by cystostomy tube drainage and delayed repair, which is certainly in concordance with the minimal acceptable treatment principles.
In summary, mass casualty events involve particular treatment protocols based on principles of evacuation, triage, and damage control. A thorough knowledge of these special diagnostic and therapeutic principles by the urologist is compulsory and bound to improve communication among the other multidisciplinary trauma team members and is finally translated into improved outcome for victims.
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