Allen F. Morey, MD, Editor

Steven J. Hudak, MD, Editor

Urologic injury often occurs in the context of severe multisystem trauma, which requires close cooperation with trauma surgeons. The urologist remains an important consultant to the trauma team, helping to ensure that the structure and function of the genitourinary system is preserved whenever possible. Immediate interventions for acute urologic injuries often require flexibility in accordance with damage control principles in critically ill patients. Minimally invasive techniques for achieving hemostasis have become mainstream among renal trauma patients, and this version of The Urologic Clinics identifies important radiographic predictors of those who may benefit from urgent angiographic intervention. The role of robotic surgery, having changed the face of urologic oncology, is now increasingly employed in complex ureteral reconstruction, especially for distal strictures.

The acute management of pelvic fracture–associated urethral injuries remains an ongoing controversy. Primary endoscopic urethral realignment is presented with important recommendations for patient selection and procedural conduct. Many of these patients will ultimately require posterior urethral reconstruction, which remains the hallmark operation for reconstructive urologists, and technical considerations for optimal outcomes are reviewed.

Significant reconstructive challenges often await the urologic trauma patient who has recovered from his associated injuries. Genital injuries are rarely life-threatening, but often become the male trauma patient’s chief concern once acute issues are resolved. Plastic surgical principles offer an important guide for optimal genital cosmesis and function. Similarly, complex proximal ureteral defects are often not amenable to robotic repair; classic reconstructive techniques, such as Boari flap, ileal ureter, and downward nephropexy, remain commonplace in the robotic era. Finally, although advances in prostate cancer management continue to improve outcomes and decrease morbidity, many men will ultimately encounter negative sequelae from oncologic treatment. Two separate articles in this issue of The Urologic Clinics are devoted to the management of 2 of the most challenging iatrogenic conditions facing urologists: radiation-induced lower genitourinary injuries and refractory postprostatectomy bladder neck contractures.

Effective rehabilitation of the urologic trauma patient remains an immensely gratifying undertaking. As the field of genitourinary reconstruction continues to evolve, we must strive to approach clinical problems in a creative, yet evidence-based manner to ensure optimal outcomes.