Urologic trauma and reconstruction
Urologic trauma encompasses injuries to any part of the urinary tract — from the kidneys down to the urethra. Injuries may be external (from accidents, falls, or violence) or iatrogenic (caused inadvertently during surgery). Both types can result in lasting functional impairment if not properly recognized and managed.
Many patients present to Dr. Wiegand months or years after the initial injury — after being managed acutely elsewhere — when stricture, obstruction, fistula, or incontinence has developed as a delayed consequence. Reconstructive surgery at that stage can achieve excellent results even in longstanding cases.
Pelvic Fracture Urethral Injury (PFUI)
Disruption of the posterior urethra from blunt pelvic trauma — the most severe urethral injury. Requires delayed posterior urethroplasty for definitive reconstruction.
Anterior Urethral Trauma
Straddle injuries, penetrating trauma, or catheter-related injuries to the bulbar or penile urethra — causing stricture that develops over weeks to months.
Bladder Trauma
Intraperitoneal or extraperitoneal bladder rupture from pelvic fracture or blunt trauma. Managed acutely, with surveillance for late complications.
Ureteral Injury
Iatrogenic injury to the ureter during gynecologic, colorectal, or vascular surgery — recognized acutely or presenting as obstruction, fistula, or urinoma.
Renal Trauma
Kidney lacerations or vascular injuries graded I–V. Most managed non-operatively; select cases require intervention for ongoing hemorrhage or devascularization.
Iatrogenic Injury
Urethral, ureteral, or bladder injury occurring as a complication of prior surgery — including prostatectomy, hysterectomy, colorectal resection, or endoscopic procedures.
Pelvic fracture urethral injury
PFUI is the most complex urethral injury and represents a significant area of Dr. Wiegand's reconstructive practice. A high-energy pelvic fracture can completely disrupt the posterior urethra — the segment between the bladder and the perineum. Immediate management involves suprapubic tube placement to divert urine while the patient recovers from associated injuries.
Definitive reconstruction — posterior urethroplasty via a perineal approach — is typically deferred for 3–6 months to allow the pelvic hematoma to resolve and tissues to mature. At that point, surgical repair achieves excellent long-term patency in the majority of patients. Dr. Wiegand has published on robotic approaches to posterior urethroplasty for complex cases including those following abdominal perineal resection.
Timing matters
Early endoscopic attempts to realign or dilate a PFUI injury often create additional scarring without achieving durable results. Waiting for proper tissue maturation before definitive urethroplasty consistently produces better outcomes. Dr. Wiegand will guide you on the right timing for your specific injury.
Evaluation of urologic trauma
Retrograde Urethrogram (RUG) & VCUG
Essential for characterizing posterior and anterior urethral injuries — defining the gap length, location, and bladder neck status prior to reconstruction.
MRI Pelvis
Particularly useful for PFUI — demonstrates the urethral gap, scar tissue, and pelvic anatomy to guide surgical approach and incision planning.
CT Urogram
For ureteral injuries and renal trauma — evaluates the full upper tract, identifies extravasation, and assesses delayed function.
Cystoscopy
Direct assessment of the bladder neck, proximal urethral stump, and mucosal integrity — critical for planning posterior urethroplasty.
Urodynamics
Bladder function evaluation prior to reconstruction — particularly important when continence or neurogenic dysfunction is a concern after pelvic trauma.
Reconstructive surgery for urologic trauma
Reconstruction after urologic trauma is tailored to the injury type, its location and severity, the time since injury, and any previous interventions. Most posterior urethral injuries are managed with perineal urethroplasty; anterior strictures with the appropriate urethroplasty technique based on length and location; and ureteral injuries with ureteroureterostomy, ureteroneocystostomy, or ileal interposition for long-segment defects.
For detailed information on specific reconstructive procedures — urethral stricture repair, ureteral reconstruction, or neurogenic bladder management following pelvic trauma — please see the relevant condition pages on this site.
Referred after failed prior repair?
Dr. Wiegand regularly accepts complex referrals for revision reconstruction after prior failed repair or multiple endoscopic interventions. Reoperative cases are more challenging but often very achievable with careful planning.
Dealing with a urologic injury or its aftermath?
Whether the injury is recent or years old, Dr. Wiegand can evaluate your situation and discuss realistic reconstruction options.
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