Genitourinary trauma: Difference between revisions
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* 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 | * Any pt with external genitialia trauma w/ hematuria, urinary retention or dysuria requires a retrograde urethrogram | ||
Revision as of 23:59, 23 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
- 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!
- 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