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Semin intervent Radiol
DOI: 10.1055/s-0045-1809957
Review Article

Interventional Radiology Management of Genitourinary Trauma: Literature, Current Practice, and Strategies for the Future

Grace L. Laidlaw
1   Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, Washington
,
Matthew Abad-Santos
1   Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, Washington
,
David S. Shin
2   Division of Vascular and Interventional Radiology, Department of Radiology, University of Southern California, Los Angeles, California
,
Ethan W. Hua
1   Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, Washington
,
Charles Hua
1   Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, Washington
,
James Jeffries
1   Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, Washington
,
Karim Vaji
1   Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, Washington
,
Eric J. Monroe
3   Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, Madison, Wisconsin
,
Jeffrey F. B. Chick
2   Division of Vascular and Interventional Radiology, Department of Radiology, University of Southern California, Los Angeles, California
› Author Affiliations
Funding None.
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Abstract

The genitourinary tract is commonly injured in blunt and penetrating trauma. Improvements in interventional radiology (IR) techniques increasingly allow for minimally invasive treatment options for a range of genitourinary injuries. Through ongoing advances in image-guided techniques, IR physicians continue to refine genitourinary trauma management, improving treatment efficacy and safety. This review describes the background, current practices, and future directions for IR-guided genitourinary trauma management.

Keywords

kidney - bladder - ureter - genitourinary - trauma - bleeding - embolization - surgery

Ethics Approval and Consent to Participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


Consent for Publication

This study was not Institutional Review Board-approved.


Authors' Contribution's

All authors contributed equally to the preparation of this study.




Publication History

Article published online:
02 July 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. BJU Int 2016; 117 (02) 226-234
    CrossrefPubMedSearch in Google Scholar
  • 2 Coccolini F, Moore EE, Kluger Y. et al; WSES-AAST Expert Panel. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14: 54
    CrossrefPubMedSearch in Google Scholar
  • 3 Bedayat A, Hassani C, Prosper AE, Chalian H, Khoshpouri P, Ruehm SG. Recent innovations in renal vascular imaging. Radiol Clin North Am 2020; 58 (04) 781-796
    PubMedSearch in Google Scholar
  • 4 White RD, Moore KS, Salahia MG. et al. Renal arteries revisited: anatomy, pathologic entities, and implications for endovascular management. Radiographics 2021; 41 (03) 909-928
    CrossrefPubMedSearch in Google Scholar
  • 5 Natsis K, Tsitouridis I, Totlis T, Levva S, Tsikaras P, Skandalakis P. Proposal for classification of the circumaortic renal collar's morphology. Am Surg 2008; 74 (12) 1190-1194
    PubMedSearch in Google Scholar
  • 6 Lescay HA, Jiang J, Leslie SW. et al. Anatomy, Abdomen and Pelvis Ureter. StatPearls. 2024
  • 7 de Treigny OM, Roumiguie M, Deudon R. et al. Anatomical study of the inferior vesical artery: is it specific to the male sex?. Surg Radiol Anat 2017; 39 (09) 961-965
    PubMedSearch in Google Scholar
  • 8 Lumen N, Kuehhas FE, Djakovic N. et al. Review of the current management of lower urinary tract injuries by the EAU trauma guidelines panel. Eur Urol 2015; 67 (05) 925-929
    PubMedSearch in Google Scholar
  • 9 Serafetinides E, Kitrey ND, Djakovic N. et al. Review of the current management of upper urinary tract injuries by the EAU trauma guidelines panel. Eur Urol 2015; 67 (05) 930-936
    PubMedSearch in Google Scholar
  • 10 Hammond NA, Lostumbo A, Adam SZ. et al. Imaging of adrenal and renal hemorrhage. Abdom Imaging 2015; 40 (07) 2747-2760
    PubMedSearch in Google Scholar
  • 11 Vaidya PN, Rathi BM, Finnigan NA. Page Kidney. StatPearls. 2024
  • 12 Moore EE, Cogbill TH, Malangoni MA. et al. Organ injury scaling. Surg Clin North Am 1995; 75 (02) 293-303
    PubMedSearch in Google Scholar
  • 13 Matsumoto MM, Reddy SN, Nadolski GJ, Shamimi-Noori S, Trerotola SO, Stavropoulos SW. Iatrogenic renal artery injury in 90 cases: arteriographic findings and outcomes after embolization for bleeding. J Vasc Interv Radiol 2023; 34 (03) 436-444
    CrossrefPubMedSearch in Google Scholar
  • 14 Engelsgjerd JS, LaGrange CA. Ureteral Injury. StatPearls. 2024
  • 15 Lopez-Gonzalez DB, Zurkiya O. Interventional radiology in renal trauma. Semin Intervent Radiol 2021; 38 (01) 113-122
    PubMedSearch in Google Scholar
  • 16 Voelzke BB, Leddy L. The epidemiology of renal trauma. Transl Androl Urol 2014; 3 (02) 143-149
    PubMedSearch in Google Scholar
  • 17 Muller A, Rouvière O. Renal artery embolization-indications, technical approaches and outcomes. Nat Rev Nephrol 2015; 11 (05) 288-301
    PubMedSearch in Google Scholar
  • 18 Esparaz AM, Pearl JA, Herts BR, LeBlanc J, Kapoor B. Iatrogenic urinary tract injuries: etiology, diagnosis, and management. Semin Intervent Radiol 2015; 32 (02) 195-208
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Zylak CM, Peterson SN. Embolization of a gonadal artery pseudoaneurysm after Whipple procedure identified using intravascular ultrasound. J Vasc Interv Radiol 2022; 33 (07) 869
    PubMedSearch in Google Scholar
  • 20 Saiga A, Aramaki T, Sato R, Asahara K, Goto H. Embolization of pseudoaneurysms in the ureteral branch of the renal artery. CVIR Endovasc 2023; 6 (01) 51
    PubMedSearch in Google Scholar
  • 21 Franco DF, Zangan SM. Interventional radiology in pelvic trauma. Semin Intervent Radiol 2020; 37 (01) 44-54
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Adnan SM, Romagnonli AN, Elansary NN. et al. Radial versus femoral arterial access for trauma endovascular interventions: a noninferiority study. J Trauma Acute Care Surg 2020; 89 (03) 458-463
    PubMedSearch in Google Scholar
  • 23 Maruhashi T, Kurihara Y, Kitamura R, Oi M, Suzuki K, Asari Y. Carbon dioxide angiography during angioembolization for trauma patients increases the detection of active bleeding and leads to reliable hemostasis: a retrospective, observational study. Eur J Trauma Emerg Surg 2024; 50 (05) 2147-2154
    PubMedSearch in Google Scholar
  • 24 Vaidya S, Tozer KR, Chen J. An overview of embolic agents. Semin Intervent Radiol 2008; 25 (03) 204-215
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Arslan B, Razavi MK, Siskin G. et al. The LAVA study: a prospective, multicenter, single-arm study of a liquid embolic system for treatment of peripheral arterial hemorrhage. J Vasc Interv Radiol 2025; 36 (03) 436-445.e2
    PubMedSearch in Google Scholar
  • 26 Yu Q, Ahmed O, Chen J, Islam Y, Funaki B, Patel M. A novel conformable embolic for selective transarterial embolization of acute hemorrhages: a technical note. CVIR Endovasc 2024; 7 (01) 78
    PubMedSearch in Google Scholar
  • 27 Hegde K, Kalva SP, Botwin A. et al. Risks of aliquot delivery of conformable embolic material: embolic dislodgement resulting in non-target embolization. J Vasc Interv Radiol 2025; 36 (03) 529-532.e1
    PubMedSearch in Google Scholar
  • 28 Bittenbinder EN, Reed AB. Advances in renal intervention for trauma. Semin Vasc Surg 2013; 26 (04) 165-169
    PubMedSearch in Google Scholar
  • 29 Ierardi AM, Floridi C, Fontana F. et al. Transcatheter embolisation of iatrogenic renal vascular injuries. Radiol Med 2014; 119 (04) 261-268
    PubMedSearch in Google Scholar
  • 30 Monroe EJ, Kogut MJ, Ingraham CR. Traumatic renal vein pseudoaneurysm. J Vasc Surg Cases 2015; 1 (02) 157-160
    PubMedSearch in Google Scholar
  • 31 Hart K, Johnson G, Steenburg SD. Renal vein injuries: a 10-year, single institution experience with a rare injury following blunt abdominal trauma. Emerg Radiol 2021; 28 (03) 533-539
    PubMedSearch in Google Scholar
  • 32 Oderich GS, Panneton JM, Hofer J. et al. Iatrogenic operative injuries of abdominal and pelvic veins: a potentially lethal complication. J Vasc Surg 2004; 39 (05) 931-936
    CrossrefPubMedSearch in Google Scholar
  • 33 Batra A, Pallister Z, Chung J, Fuller K, O'Mahony C, Galván NT. Transplant renal vein thrombosis rescued in a pediatric patient using suction thrombectomy. Tex Heart Inst J 2023; 50 (01) e217643
    PubMedSearch in Google Scholar
  • 34 Kim HS, Fine DM, Atta MG. Catheter-directed thrombectomy and thrombolysis for acute renal vein thrombosis. J Vasc Interv Radiol 2006; 17 (05) 815-822
    PubMedSearch in Google Scholar
  • 35 Ericson C, Baird B, Broderick GA. Management of priapism: 2021 update. Urol Clin North Am 2021; 48 (04) 565-576
    PubMedSearch in Google Scholar
  • 36 Chick JFB, J. Bundy J, Gemmete JJ, Srinivasa RN, Dauw C, Srinivasa RN. Selective penile arterial embolization preserves long-term erectile function in patients with nonischemic priapism: an 18-year experience. Urology 2018; 122: 116-120
    PubMedSearch in Google Scholar
  • 37 Pereira BM, Ogilvie MP, Gomez-Rodriguez JC. et al. A review of ureteral injuries after external trauma. Scand J Trauma Resusc Emerg Med 2010; 18: 6
    PubMedSearch in Google Scholar
  • 38 Egilmez H, Oztoprak I, Atalar M. et al. The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience. Acta Radiol 2007; 48 (07) 806-813
    PubMedSearch in Google Scholar
  • 39 Venkatesan AM, Kundu S, Sacks D. et al. Society of Interventional Radiology Standards of Practice Committee. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. J Vasc Interv Radiol 2010; 21 (11) 1611-1630 , quiz 1631
    CrossrefPubMedSearch in Google Scholar
  • 40 Thornton RH, Covey AM. Urinary drainage procedures in interventional radiology. Tech Vasc Interv Radiol 2016; 19 (03) 170-181
    PubMedSearch in Google Scholar
  • 41 Farrell TA, Hicks ME. A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol 1997; 8 (05) 769-774
    CrossrefPubMedSearch in Google Scholar
  • 42 Hausegger KA, Portugaller HR. Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications. Eur Radiol 2006; 16 (09) 2016-2030
    CrossrefPubMedSearch in Google Scholar
  • 43 Pabon-Ramos WM, Dariushnia SR, Walker TG. et al. Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol 2016; 27 (03) 410-414
    PubMedSearch in Google Scholar
  • 44 Roberts DG, Patel RB, Genshaft SJ. et al. Interventional radiology image-guided suprapubic cystostomy using trocar versus Seldinger technique: a comparative analysis of outcomes and complications. Urology 2020; 142: 207-212
    PubMedSearch in Google Scholar
  • 45 Cronin CG, Prakash P, Gervais DA. et al. Imaging-guided suprapubic bladder tube insertion: experience in the care of 549 patients. AJR Am J Roentgenol 2011; 196 (01) 182-188
    PubMedSearch in Google Scholar
  • 46 Augustin AM, Koneval L, Kalogirou C, Kocot A, Kickuth R. Percutaneous transrenal ureteral plug embolization: is there a need for tissue adhesives?. Diagn Interv Radiol 2021; 27 (06) 762-767
    PubMedSearch in Google Scholar
  • 47 Popuri R, Zuckerman DA. Ureteral interventions. Semin Intervent Radiol 2011; 28 (04) 392-395
    PubMedSearch in Google Scholar
  • 48 Saad WE, Kalagher S, Turba UC. et al. Ureteric embolization for lower urinary tract fistulae: use of two amplatzer vascular plugs and N-butyl cyanoacrylate employing the “sandwich” technique. Cardiovasc Intervent Radiol 2013; 36 (04) 1068-1072
    PubMedSearch in Google Scholar
  • 49 Kozar RA, Crandall M, Shanmuganathan K. et al; AAST Patient Assessment Committee. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg 2018; 85 (06) 1119-1122
    CrossrefPubMedSearch in Google Scholar