Genitourinary trauma: Difference between revisions

Revision as of 03:47, 13 June 2012

Majority of blunt trauma injuries present w/ hematuria
Renal pedicle injuries and penetrating injuries to ureter may not cause hematuria
Renal injuries are a/w flank hematoma, lower rib fx, penetrating wounds to flanks

Suprapubic pain, blood at meatus, inability to void
Gross hematuria is present in 95% of significant bladder injuries
- Pelvic fracture + gross hematuria = bladder rupture
- <1% of all blunt bladder injuries p/w UA w/ <25 RBCs/HPF
Bladder Rupture
- Extraperitoneal
  - Assoc w/ pelvic fx and laceration by bony fragments
  - Leakage of urine into perivesicular space
  - "Tear drop" shape on imaging
- Intraperitoneal
  - Assoc w/ compresive force in presence of full bladder

Imaging
- Retrograde cystogram (CT or plain film) indicated for:
- Gross hematuria
  - Inability to void
  - Pelvic fx in assoc w/ microscopic hematuria
  - Clinical suspicion of bladder injury
- CT A/P w/ IV contrast NOT sensitive enough for bladder rupture
Treatment
- Extraperitoneal rupture - nonoperative management with bladder cathether drainage
- Intraperitoneal rupture - primary surgical repair

Anterior
- Located anterior to the membranous urethra
- Straddle injuries, self-instrumentation
Posterior
- Located in the membranous and prostatic urethra
- Due to blunt trauma from massive deceleration
- Often accompanies pelvic fx

Hematuria, dysuria, inability to void, blood at meatus
Vaginal bleeding
Perineal hematoma
High-riding or detached prostate
- Associated w/ complete posterior urethral disruption

- Posterior urethral injury
  - Suprapubic cathether placement
  - Surgery is usually performed weeks later
- Anterior urethral injury
  - Penetrating injuries require surgical exploration and repair

Presentation
- Blunt trauma due to impingement against symphysis pubis
  - Will have contusion or rupture based on whether tunica albuginea is disrupted
  - Large, blue, tender scrotal mass (hematocele),
Imaging
- Scrotal ultrasound required for all blunt testicular injuries
  - Reliable in diagnosing ruptured testes
Treatment
- Most testicular injuries are managed conservatively
  - Analgesia, ice, elevation, scrotal support, urology f/u
- Tesicular rupture requires early surgical intervention

General
- Any pt w/ trauma to genitalia w/ a prothesis in place should be seen by a urologist
- All penetrating trauma to the penis requires surgical consultation
- Avulsed penile skin should not be reapplied (invariably becomes necrotic and infected)
Penile fracture
- Results from rupture of corpus cavernosum
  - Cracking sound followed by pain, detumescence, swelling, discoloration, deformity
- Obtain retrograde urethrogram to r/o urethral injury
- Requires operative removal of blood cut and repair of tunica albuginea
Penile contusion
- Treat conversevely ice, rest, elevation, foley placement if pt unable to void
Zipper Injury
- Mineral oil and lidocaine infiltration can be used to free the penile skin
- Wire-cutting or bone-cutting pliers can be used to cut the median bar of the zipper
Traumatic epididymitis
- Noninfectious inflammatory condition that occurs w/in few days after trauma to testis
  - Treatment is similar to that for nontraumatic epididymitis

Perform speculum examination when vaginal hemorrhage or hematoma is present to exclude vaginal laceration

Tintinalli

Authors:

@@ Line 17: / Line 17: @@
 ===[[Renal Injuries]]===
-===Ureter Injuries===
+===[[Ureter Injuries]]===
-*90% of injuries occur from penetrating injury
-*Isolated ureter injury is rare
-*Absence of hematuria does NOT rule out ureteral injury
-====Management====
-*If CT is nondiagnostic but high index of suspicion perform IV urography or retrograde pyelography
-*Treatment
-**Surgery
-*Disposition
-**Admit
 ==Lower Tract Injuries (bladder + urethra + genitalia)==