Management of genitourinary trauma – current evaluation from the Sub-Saharan region: A systematic review

Table 1 Penile trauma, causes of injury, treatment and complications

Ref.	Country/Territory	No. of patients	Age range in yr	Mean age in yr	Penile injury	Causes of penile injury	Treatment	Complications
Sow et al[29]	Senegal	23	19-47	32.4	Fracture of tunica albuginea-82.6%; Fracture of tunica albuginea + partial urethral injury; Rupture of the penile dorsal vein	Sexual intercourse, masturbation, firearm, self-circumcision attempt	Evacuation of hematoma and repair of the albuginea	ED, coital penile pain, penile chordee
Paré et al[30]	Burkina	6	30-43	38.3	Fracture of tunica albuginea - 83.3%; Penile Contusion	Sexual intercourse	Evacuation of hematoma and repair of the albuginea	No ED
Odzébé et al[31]	Congo Brazzaville	09	25-73	46.3	Fracture of tunica albuginea	Sexual intercourse; Masturbation	Evacuation of hematoma and repair of the albuginea	ED; Penile chordee
Oranusi et al[32]	Nigeria	23	0.003-43	28.9	Penile fracture (34.8%) - (Sexual intercourse); Genital mutilation 26% (self-inflicted/assault); Post circumcision 13% (untrained nurses), Penile gunshot injury		Repair of albuginea, refashioning of residual penile stump, repair of albuginea	Not specified
Omisanjo et al[33]	Nigeria	15	23-56	35.2	Penile fracture 100% + concomitant urethral injury 26.7%	Sexual intercourse 66.7%; Rolling over erect penis 20% Masturbation 13%	Evacuation of hematoma and repair of the albuginea	ED 6.7%; Penile chordee 13.3%
Barry et al[34]	Guinea	22	22-51	37.8	Penile fracture 100%	Sexual intercourse 59.1%; Masturbation 31.8%; Rolling over erect penis 9.1%	Evacuation of hematoma and repair of the albuginea	No ED

ED: Erectile dysfunction.

Table 2 Urological complications of obstetrics and gynecology surgeries

Series	Country/territory	Patient population	Age range in yr	Mean age in yr	Urological injury	Causes of injury	Intervention
Papoola et al[37]	Nigeria	11	28-65	43.8	Ureteric injury (45.5%); Bladder injury (18.2%)	TAH-60%; Ovariectomy	UNC: 36%; Uretero-ureterostomy; Bladder repair; Catheter drainage
Kingsley et al[38]	Nigeria	20	N/A	34.5 ± 3.8	L. ureteric injury (50%); R. ureteric injury (21.4%); Bilateral (28.6%)	TAH-55%; Myomectomy, CS, excision of right colonic tumor	UNC: 67.8%; Psoas hitch, Boari’s flap, TUU, R. Nephroureterectomy
Ekeke et al[39]	Nigeria	25/8270	24-62	38.4	L. ureteric injury (37.5%); R. ureteric injury (33.3%); Bilateral (29.2%); Bladder injury (28%)	TAH-48%, Subtotal H-16%, CS:12%, ovariectomy, VVF repair.	Ureteric laceration repair- 40%, UNC: 44%, Boari’s flap, bladder repair
Mensah et al[40]	Ghana	14	18-74	N/A	Bilateral ureteral injury	TAH-92.9%; VVF repair-7.1%	Dialysis-36%; UNC, deligation, psoas hitch, TUU
Sebukoto et al[41]	Tanzania	105/11219	N/A	N/A	Ureteral injury 17.2%; R. ureter 6.7%; L. ureter 4.8%; Bilateral 5.7%; Bladder injury 3.8%	C-Section 34.3%; TAH- 17.1%
Chianakwana et al[42]	Nigeria	32	N/A	N/A	Ureteric injury 87%; Bladder injury 9.4%; Urethral Injury 2.1%	TAH, Myomectomy	UNC 81.3%; Bladder repair; Tube ureterostomy
Obarisiagbon et al[43]	Nigeria	16	16-50	41.5	Left ureter 44%;Right ureter 12.5%; Bilateral 18.8%; Bladder injury 25%	TAH 75%; C-section 31%	UNC 68.8%; Bladder repair; Conservative; Nephrectomy

L: Left; R: Right; N/A: Not available; CS: Cesarean section; TAH: Total abdominal hysterectomy; TUU: Transureteroureterostomy; UNC: Ureteroneocystostomy; VVF: Vesicovaginal fistula; H: Hysterectomy.

Table 3 Renal injury scale – American Association for Surgery of Trauma[3]

Grade	Type	Description
Grade (I)	Contusion	Gross or microscopic hematuria
	Hematoma	Non-expanding subcapsular hematoma, parenchyma spared
Grade (II)	Hematoma	Confined non-expanding perirenal hematoma
	Laceration	< 1 cm parenchymal tear without urine extravasation
Grade (III)	Laceration	> 1 cm parenchymal tear without urine leakage
Grade (IV)	Laceration	Parenchymal tear across the renal cortex, medulla and collecting system
	Vascular	Injury to major branch of renal artery or vein with contained hemorrhage
Grade (V)	Laceration	Kidney is completely shattered
	Vascular	Devascularized kidney from renal hilum avulsion

Citation: Coccolini F, Moore EE, Kluger Y, Biffl W, Leppaniemi A, Matsumura Y, Kim F, Peitzman AB, Fraga GP, Sartelli M, Ansaloni L, Augustin G, Kirkpatrick A, Abu-Zidan F, Wani I, Weber D, Pikoulis E, Larrea M, Arvieux C, Manchev V, Reva V, Coimbra R, Khokha V, Mefire AC, Ordonez C, Chiarugi M, Machado F, Sakakushev B, Matsumoto J, Maier R, di Carlo I, Catena F; WSES-AAST Expert Panel. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14: 54. Copyright© The Authors 2019. Published by BMC. The authors have obtained the permission for table using from the BMC Publishing Group (Supplementary material).