The consensus on genitourinary trauma continues this month with the statement on bladder trauma from several internationally recognised experts on the subject. They describe blunt, penetrating and iatrogenic injuries and their management, considering paediatric injuries separately. They underline the importance of prompt diagnosis and treatment, stressing that problems raised when the diagnosis is delayed.

We examined 82 healthy volunteers, 61 subfertile men with varicoceles and 27 subfertile men without varicoceles for testicular size and semen quality. In 13 volunteers we found unsuspected varioceles and a left testicle significantly smaller than the other 69 volunteers. The size of the right testicle and the sperm density in these patient groups were similar. Both testicles of subfertile male subjects with varicoceles were significantly smaller than the testicles of subfertile male subjects without varicoceles. However, the sperm densities of these 2 groups were similar. Finally, although subfertile male subjects with varicoceles had obviously statistically lower sperm densities than volunteers with varicoceles, the testicular sizes were similar. Perhaps varicocele ligations should be performed on all male subjects with this lesion at an early age to prevent progressive testicular atrophy and decreased fertility potential.

We treated 27 patients with iatrogenic ureteral injuries during a 6-year period. Gynecological operations were the most common antecedent surgical procedures (52 per cent). The diagnosis of ureteral injury was made immediately in 4 patients and was delayed 1 to 34 days in 23. Three of the 4 injuries recognized during an operation were repaired successfully at the time of injury; the primary repair in the remaining patient leaked and ultimately resulted in a nephrectomy. In the delayed diagnosis group retrograde ureteral catheterization was successful in only 1 of 20 attempts. Of the 23 patients with injuries recognized in the postoperative period 11 were managed successfully with percutaneous nephrostomy (with or without stenting) alone, 3 required surgical repair after temporary percutaneous nephrostomy drainage, 4 were treated surgically without prior nephrostomy drainage and 1 had spontaneous resolution of hydronephrosis. The remaining 3 patients required nephrectomy: 1 because of a urinary fistula in a previously irradiated field, 1 because of a concomitant (ipsilateral) renal cell carcinoma and 1 because of renal hypertension. Percutaneous nephrostomy or ureteral stenting was successful as primary therapy in 73 per cent of the patients in whom it was used.

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