Genitourinary trauma: Difference between revisions
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==Upper | ==Background== | ||
*Majority of blunt trauma injuries present with hematuria | [[File:Urinary system.png|thumb|'''(1) Human urinary system:''' (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra. <Br>'''Additional structures:''' (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.]] | ||
[[File:Blausen 0592 KidneyAnatomy 01.png|thumb|Renal anatomy.]] | |||
[[File:PMC5265200 13244 2016 536 Fig1 HTML.png|thumb|Perinephric space with exaggerated pararenal space to show retroperitoneal structures. Perinephric bridging septa are seen between the left kidney and the adjacent renal fascia.]] | |||
*Typically divided into: | |||
**Upper tract injuries (kidney + ureter) | |||
**Lower tract Injuries (bladder + urethra + genitalia) | |||
==Clinical Features== | |||
===Upper tract injury=== | |||
*Majority of blunt trauma injuries present with [[hematuria]] | |||
*Renal pedicle injuries and penetrating injuries to ureter may not cause hematuria | *Renal pedicle injuries and penetrating injuries to ureter may not cause hematuria | ||
*Renal injuries are | *Renal injuries are associated with flank hematoma, lower rib fracture, penetrating wounds to flanks | ||
===Lower tract injury=== | |||
*Often accompanied by signs of [[pelvic fracture]] | |||
=== | ==Differential Diagnosis== | ||
{{Lower GU trauma DDX}} | |||
{{Abdominal trauma DDX}} | |||
==Evaluation== | |||
===Workup=== | |||
*Who to image? | *Who to image? | ||
**Penetrating Trauma | **Penetrating Trauma | ||
| Line 10: | Line 27: | ||
**Blunt Trauma | **Blunt Trauma | ||
***Gross hematuria | ***Gross hematuria | ||
***Hypotension and any degree of hematuria | ***[[Hypotension]] and any degree of hematuria | ||
***Child with >50rbc/HPF | ***Child with >50rbc/HPF | ||
***High index of suspicion for renal trauma | ***High index of suspicion for renal trauma | ||
| Line 16: | Line 33: | ||
****Multiple trauma patient | ****Multiple trauma patient | ||
=== | ===Diagnosis=== | ||
* | *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 | |||
== | ==Management== | ||
== | ==Disposition== | ||
==See Also== | ==See Also== | ||
*[[Traumatic Foley Catheter Removal]] | *[[Traumatic Foley Catheter Removal]] | ||
*[[Abdominal trauma]] | *[[Abdominal trauma]] | ||
*[[Trauma (main)]] | |||
==External Links== | |||
==References== | ==References== | ||
<references/> | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category:Urology]] | [[Category:Urology]] | ||
Latest revision as of 17:16, 3 May 2023
Background
- Typically divided into:
- Upper tract injuries (kidney + ureter)
- Lower tract Injuries (bladder + urethra + genitalia)
Clinical Features
Upper tract injury
- 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
Lower tract injury
- Often accompanied by signs of pelvic fracture
Differential Diagnosis
Genitourinary Trauma
- Urinary system
- Genital
- Other
- Child abuse
- Pelvic fracture (often accompanies)
- Sexual assault
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
Evaluation
Workup
- 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 patient
- Penetrating Trauma
Diagnosis
- 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