The American College for Surgeons (ACS) has released new guidelines on best practices for the management of genitourinary injuries, offering clinicians evidence-based recommendations for treating patients with traumatic injuries to the kidneys, bladder, ureters, urethra, and genitalia.1
Avery Nathens, MD, PhD, FACS
“Traumatic genitourinary injuries require prompt and expert management to prevent life-threatening complications and ensure optimal long-term outcomes,” said Avery Nathens, MD, PhD, FACS, Medical Director of Trauma Quality Programs at ACS, in a news release from the organization.2 “These guidelines provide a multidisciplinary, evidence-based framework to help trauma teams deliver high-quality care to patients with injuries that have the potential to cause significant morbidity.”
According to the authors, these guidelines were developed based on a need for broader dissemination of guidelines across leadership of trauma systems, who establish and implement protocols for the management of patients with genitourinary injuries.
The authors explained, “Because the initial triage and diagnostic workup is most commonly performed by emergency physicians and trauma surgeons, it is necessary to establish Best Practices Guidelines that incorporate GU system evaluation and management protocols targeted to urologists and all clinicians who face these relatively common injuries.”
Thus, the updated guidelines were developed with input from expert urologists, trauma surgeons, and military medical professionals.
According to the ACS, key points from the guidelines include:
- “Renal Trauma: Nonoperative management is recommended for hemodynamically stable patients, even with high-grade injuries. Angioembolization is emphasized as a key adjunct for controlling bleeding.
- Bladder and Urethral Injuries: Detailed protocols for imaging (e.g., CT cystography, retrograde urethrogram) and surgical repair, including special considerations for pelvic fracture-associated injuries.
- Ureteral Injuries: Recommendations for endoscopic and surgical repair, with a focus on preserving renal function.
- Genital Trauma: Guidelines for managing penile, scrotal, and female genital injuries, including bite wounds and fractures.
- Special Populations: Tailored recommendations for pediatric and older adult patients, addressing unique social, anatomical, and physiological considerations.”
In addition to these key points, the guidelines also include sections on the initial evaluation of genitourinary trauma, as well as imaging protocols. The new guidelines also place special emphasis on pediatric and older adult populations, as well as specific recommendations for both male and female anatomy, as these groups may have differing needs, the ACS noted.
For example, the authors explained that pediatric patients most often present with trauma following motor vehicle crashes, contact sports, bicycling, and falls in bathtubs, on the playground, or from a trampoline. In older adults, these injuries are most commonly due to blunt trauma, which can include falls and motor vehicle collisions.
Markedly, the authors reported that urologic injuries account for 9% of the total injuries sustained among older adults. This number has been rising with the aging population, underscoring the growing need for expert consensus.
“Notably, the authors of these guidelines took great care to include considerations for special populations, including pediatrics and geriatrics, whose needs might differ,” concluded Nathens, who is also the Chief of Surgery at Sunnybrook Health Sciences Centre in Toronto, Canada, in the news release.2 “This ensures equitable and effective care for all trauma patients.”
REFERENCES
1. Best practices guidelines for the management of genitourinary injuries. American College of Surgeons. August 2025. Accessed August 29, 2025. https://www.facs.org/media/ya5hcu0s/genitourinary_guidelines.pdf
2. American College of Surgeons releases new best practices guidelines for management of genitourinary injuries. News release. August 26, 2025. Accessed August 29, 2025. https://www.newswise.com/articles/american-college-of-surgeons-releases-new-best-practices-guidelines-for-management-of-genitourinary-injuries