Genitourinary trauma: Difference between revisions

Revision as of 03:50, 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

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 22: / Line 22: @@
 *Often accompany pelvic fracture
-===Bladder Injury===
+===[[Bladder Injury]]===
-====Presentation====
-*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
-====Management====
-*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
 ===Urethral Injury===
 ====Types====