Genitourinary trauma

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

Lower Tract Injuries (bladder + urethra + genitalia)

• Often accompany pelvic fracture

Testicular Injury

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