Genitourinary trauma: Difference between revisions
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****Deceleration injuries even with no hematuria | ****Deceleration injuries even with no hematuria | ||
****Multiple trauma patient | ****Multiple trauma patient | ||
*CT with IV contrast is the gold standard in assessing renal and GU trauma | |||
**More sensitive and specific than IVP, ultrasound, or angiography | |||
**However, can miss significant injuries to the renal pelvis, collecting system and ureter given CT generally obtained before contrast is excreted in the urine. | |||
**If initial CT shows high grade renal injury (grade IV of V), UPJ injury, or concern for ureteral injury, should obtain additional 10 minute delayed CT<ref>Morey AF, Brandes S, Dugi DD 3rd, et al. Urotrauma: AUA guideline. J Urol. 2014;192(2):327-335.</ref><ref>33.* Holevar M, DiGiacomo C, Ebert J, et al. Practice management guidelines for the evaluation of genitourinary trauma. </ref> | |||
**Exception to using IVP over CT is perioperatively in unstable patients requiring immediate operation for other injuries | |||
**Note, CT A/P with IV contrast NOT sensitive enough for [[bladder trauma|bladder rupture]], requires CT cystography | |||
===Types=== | ===Types=== | ||
Revision as of 22:01, 19 July 2017
Upper Tract Injuries (kidney + ureter)
- Majority of blunt trauma injuries present with hematuria
- Renal pedicle injuries and penetrating injuries to ureter may not cause hematuria
- Renal injuries are associated with flank hematoma, lower rib fracture, penetrating wounds to flanks
Evaluation
- Who to image?
- Penetrating Trauma
- Any degree of hematuria
- Blunt Trauma
- Gross hematuria
- Hypotensionand any degree of hematuria
- Child with >50rbc/HPF
- High index of suspicion for renal trauma
- Deceleration injuries even with no hematuria
- Multiple trauma patient
- Penetrating Trauma
- CT with IV contrast is the gold standard in assessing renal and GU trauma
- More sensitive and specific than IVP, ultrasound, or angiography
- However, can miss significant injuries to the renal pelvis, collecting system and ureter given CT generally obtained before contrast is excreted in the urine.
- If initial CT shows high grade renal injury (grade IV of V), UPJ injury, or concern for ureteral injury, should obtain additional 10 minute delayed CT[1][2]
- Exception to using IVP over CT is perioperatively in unstable patients requiring immediate operation for other injuries
- Note, CT A/P with IV contrast NOT sensitive enough for bladder rupture, requires CT cystography
Types
Lower Tract Injuries (bladder + urethra + genitalia)
- Often accompany pelvic fracture
Genitourinary Trauma
- Urinary system
- Genital
- Other
- Child abuse
- Pelvic fracture (often accompanies)
- Sexual assault
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma