Genitourinary trauma: Difference between revisions
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===[[Bladder Injury]]===
===[[Bladder Injury]]===
===Urethral Injury===
===[[Urethral Injury]]===
====Types====
*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
====Presentation====
*Hematuria, dysuria, inability to void, blood at meatus
*Vaginal bleeding
*Perineal hematoma
*High-riding or detached prostate
**Associated w/ complete posterior urethral disruption
====Management====
=====Imaging=====
*Retrograde urethrogram
**Must perform before catheterization to prevent further urethral injury
**60 mL of water soluble contrast in toomey syringe
**Inject into urethra, shoot KUB during last 10 mL
**No bladder filling with extravasation - complete tear
**Bladder filling with extravasation - partial tear
 
=====Treatment=====
**Posterior urethral injury
***Suprapubic cathether placement
***Surgery is usually performed weeks later
**Anterior urethral injury
***Penetrating injuries require surgical exploration and repair
 
===Genitalia Injury===
===Genitalia Injury===
====Testicular Injury====
====Testicular Injury====

Revision as of 03:51, 13 June 2012

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
  • Renal injuries are a/w flank hematoma, lower rib fx, penetrating wounds to flanks

Diagnosis

  • Who to image?
    • Penetrating Trauma
      • Any degree of hematuria
    • Blunt Trauma
      • Gross hematuria
      • Hypotension and any degree of hematuria
      • Child with >50rbc/HPF
      • High index of suspicion for renal trauma
        • Deceleration injuries even with no hematuria
        • Multiple trauma pt

Renal Injuries

Ureter Injuries

Lower Tract Injuries (bladder + urethra + genitalia)

  • Often accompany pelvic fracture

Bladder Injury

Urethral Injury

Genitalia Injury

Testicular Injury

  • 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

Penile Injury

  • 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

Vaginal Injury

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

Source

Tintinalli

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