Genitourinary trauma

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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
  • 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

Differential Diagnosis

Abdominal Trauma

See Also

References

  1. Morey AF, Brandes S, Dugi DD 3rd, et al. Urotrauma: AUA guideline. J Urol. 2014;192(2):327-335.
  2. 33.* Holevar M, DiGiacomo C, Ebert J, et al. Practice management guidelines for the evaluation of genitourinary trauma.