Urologic trauma encompasses a spectrum of injuries involving the kidney, ureter, bladder, and urethra, with management strategies increasingly emphasizing organ preservation through minimally invasive, image-guided approaches. The updated American Association for the Surgery of Trauma 2025 grading system provides the most recent guideline for renal trauma classification, reflecting evolving imaging standards and management principles. In parallel, interventional radiology (IR) has assumed an increasingly important role in contemporary trauma care, offering effective, organ-preserving solutions through endovascular and percutaneous techniques. Renal trauma, the most frequent form of genitourinary injury, is now primarily managed non-operatively in hemodynamically stable patients, with transcatheter arterial embolization and stent-based repair serving as cornerstones of hemorrhage control and renal salvage in high-grade lesions. Clinical evidence demonstrates that selective or superselective embolization achieves high technical success and renal preservation, consolidating IR as a key component of multidisciplinary trauma management. Injuries to the lower urinary tract remain complex, but minimally invasive, image-guided interventions are increasingly recognized as integral to modern care, particularly in controlling hemorrhage and preserving function. Superselective embolization, percutaneous urine diversion, and fluoroscopic urethral realignment exemplify how IR provides life-saving, organ-preserving options for ureteral, bladder, and urethral trauma. Collectively, these developments underscore the expanding impact of IR across the full spectrum of urologic trauma management.

We present a rare case of traumatic ureteric artery bleeding successfully treated with transcatheter arterial embolization. A 65-year-old male with blunt abdominal trauma and hypotension was found to have a left retroperitoneal hematoma with active extravasation on CT. Initial angiography showed no visible bleeding; however, cone-beam CT revealed active hemorrhage from a ureteric artery displaced by the hematoma. Selective embolization using n-butyl cyanoacrylate and ethiodized oil was performed, resulting in hemodynamic stabilization. Follow-up imaging demonstrated resolution of bleeding and positional change of the ureteric artery as the hematoma resolved. This case highlights the diagnostic value of cone-beam CT and the importance of considering ureteric artery injury in cases of unexplained retroperitoneal hemorrhage.

Suture-mediated vascular closure devices (SMVCD) can be applied to close non-vascular structures, although this represents an off-label use. A 53-year-old woman who underwent hysterectomy and chemoradiation therapy due to endometrioid adenocarcinoma two years ago presented for generalized peritonitis due to anastomotic perforation following adhesiolysis and resection. CT revealed multifocal peritoneal abscesses. During perigastric fluid drainage, a pigtail drainage catheter was inadvertently placed into the stomach. To reduce the risk of gastroperitoneal fistula and peritonitis, the gastrostomy site was percutaneously closed using an SMVCD. Immediately after closure, gastrography using orally administered contrast medium and a 10-month follow-up CT demonstrated no leakage or procedure-related complications. This case suggests the potential for safe off-label use of vascular closure devices in the closure of gastrointestinal tract punctures.