The World Society of Emergency Surgery (WSES) has reported a classification for urotrauma.
Patient selection: blunt or penetrating injury to the ureter, bladder or urethra
If the patient is hemodynamically unstable, then intraoperative inspection is performed. Else imaging studies are performed to evaluate the patient prior to any surgery.
Injury to the ureter or renal pelvis:
(1) if a contusion and/hematoma is present, then a urinary catheter with/without stent is placed.
(2) if there is dissection, then there is stent placement with/without nephrostomy and delayed repair if necessary.
(3) if there is avulsion then a stent with/without nephrostomy is placed followed by surgical repair
If the bladder is ruptured:
(1) intraperitoneal rupture: surgical repair, drain placement, and urinary catheter
(2) extraperitoneal rupture: urinary catheter in noncomplicated cases and surgical repair if complicated
If there is urethral trauma:
(1) anterior and penetrating: immediate repair
(2) anterior and blunt trauma: endoscopic realignment if possible, urine drain, delayed surgical repair
(3) posterior: endoscopic realignment if possible, urine drain, and delayed surgical repair
