Genitourinary trauma: Difference between revisions
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*Signs: Blood at meatus, high prostate, difficulty voiding | *Signs: Blood at meatus, high prostate, difficulty voiding | ||
*Management | *Management | ||
*Presence of urethral injury should be ruled out prior to foley insertion! | **Presence of urethral injury should be ruled out prior to foley insertion! | ||
*Retrograde urethogram | **Retrograde urethogram | ||
*Suprapubic cystotomy to allow drainage of bladder | **Suprapubic cystotomy to allow drainage of bladder | ||
*Bladder Rupture | *Bladder Rupture | ||
*Extraperitoneal | **Extraperitoneal | ||
*Assoc w/ pelvic fx and laceration by bony fragments | ***Assoc w/ pelvic fx and laceration by bony fragments | ||
*Leakage of urine into perivesicular space | ***Leakage of urine into perivesicular space | ||
*Intraperitoneal | **Intraperitoneal | ||
*Assoc w/ compresive force in presence of full bladder | ***Assoc w/ compresive force in presence of full bladder | ||
*Pelvic fracture + gross hematuria = bladder rupture! | **Pelvic fracture + gross hematuria = bladder rupture! | ||
*Fewer than 1% of all blunt bladder injuries present with urinalysis w/ <25 RBCs/HPF | *Fewer than 1% of all blunt bladder injuries present with urinalysis w/ <25 RBCs/HPF | ||
*Signs: blood at meatus, inability to void, suprapubic pain | *Signs: blood at meatus, inability to void, suprapubic pain | ||
*Management | *Management | ||
*Bladder drainage via foley cather | **Bladder drainage via foley cather | ||
*Diagnosic w/u indicated for patients with: | **Diagnosic w/u indicated for patients with: | ||
*Gross hematuria | ***Gross hematuria | ||
*Inability to void | ***Inability to void | ||
*Pelvic ring fx in assoc w/ microscopic hematuria | ***Pelvic ring fx in assoc w/ microscopic hematuria | ||
*Retrograde cystography | *Retrograde cystography | ||
*A "tear drop" shape suggests extraperitoneal bladder rupture | **A "tear drop" shape suggests extraperitoneal bladder rupture | ||
*A routine abd/pelvis CT is not sensitive for bladder rupture! | *A routine abd/pelvis CT is not sensitive for bladder rupture! | ||
*Need retrograde contrast | **Need retrograde contrast | ||
*Extraperitoneal rupture - nonoperative management with simple urinary drainage | *Extraperitoneal rupture - nonoperative management with simple urinary drainage | ||
*Intraperitoneal rupture - primary surgical repair | *Intraperitoneal rupture - primary surgical repair | ||
*External Genitalia Injury | *External Genitalia Injury | ||
*If suspect testicular injury obtain ultrasound | **If suspect testicular injury obtain ultrasound | ||
*Any pt with external genitialia trauma w/ hematuria, urinary retention or dysuria requires a retrograde urethrogram | **Any pt with external genitialia trauma w/ hematuria, urinary retention or dysuria requires a retrograde urethrogram | ||
Reference: Harwood-Nuss | Reference: Harwood-Nuss | ||
[[Category:Trauma]] | |||
Revision as of 12:32, 24 June 2011
Upper Tract Injuries (kidney + ureter)
- Majority of blunt trauma injuries present w/ hematuria
- Renal pedicle injuries and penetrating injuries to ureter may not cause hematuria!
- AAST Grading System for renal injuries
- Non-operative management
- Grade I: Cortex contusion
- Grade II: Cortex laceration
- Possible operative management
- Grade III: Corticomedullary junction laceration
- Grade IV: Collecting system laceration
- Grade III: Corticomedullary junction laceration
- Operative management
- Grade V: Shattered kidney, thrombosis of renal artery, avulsion of hilum
- Who to image?
- Penetrating trauma
- Blunt trauma with gross hematuria
- Blunt trauma with microscopic hematuria (>5 rbc/HPF) and hemodynamic instability
- High-energy deceleration mechanism or suspected associated intra-abdominal injuries
- Disposition
- Majority of blunt renal injuries and all penetrating renal injuries require admission
Lower Tract Injuries (bladder + urethra + genitalia)
- Often accompany pelvic fracture
- Urethral Injuries
- Anterior: Self-instrumentation, falls, straddle injuries
- Posterior: Accompany pelvic fx
- Perform pelvic exam in all women with pelvic fractures!
- Signs: Blood at meatus, high prostate, difficulty voiding
- Management
- Presence of urethral injury should be ruled out prior to foley insertion!
- Retrograde urethogram
- Suprapubic cystotomy to allow drainage of bladder
- Bladder Rupture
- Extraperitoneal
- Assoc w/ pelvic fx and laceration by bony fragments
- Leakage of urine into perivesicular space
- Intraperitoneal
- Assoc w/ compresive force in presence of full bladder
- Pelvic fracture + gross hematuria = bladder rupture!
- Extraperitoneal
- Fewer than 1% of all blunt bladder injuries present with urinalysis w/ <25 RBCs/HPF
- Signs: blood at meatus, inability to void, suprapubic pain
- Management
- Bladder drainage via foley cather
- Diagnosic w/u indicated for patients with:
- Gross hematuria
- Inability to void
- Pelvic ring fx in assoc w/ microscopic hematuria
- Retrograde cystography
- A "tear drop" shape suggests extraperitoneal bladder rupture
- A routine abd/pelvis CT is not sensitive for bladder rupture!
- Need retrograde contrast
- Extraperitoneal rupture - nonoperative management with simple urinary drainage
- Intraperitoneal rupture - primary surgical repair
- External Genitalia Injury
- If suspect testicular injury obtain ultrasound
- Any pt with external genitialia trauma w/ hematuria, urinary retention or dysuria requires a retrograde urethrogram
Reference: Harwood-Nuss