Genitourinary trauma: Difference between revisions
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Upper Tract Injuries (kidney + ureter) | ==Upper Tract Injuries (kidney + ureter)== | ||
*Majority of blunt trauma injuries present w/ hematuria | *Majority of blunt trauma injuries present w/ 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! | ||
===AAST Grading System for renal injuries== | |||
*Non-operative management | *Non-operative management | ||
**Grade I: Cortex contusion | **Grade I: Cortex contusion | ||
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*Operative management | *Operative management | ||
**Grade V: Shattered kidney, thrombosis of renal artery, avulsion of hilum | **Grade V: Shattered kidney, thrombosis of renal artery, avulsion of hilum | ||
===Diagnosis=== | |||
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 | *Often accompany pelvic fracture | ||
*Urethral Injuries | *Urethral Injuries | ||
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**Retrograde urethogram | **Retrograde urethogram | ||
**Suprapubic cystotomy to allow drainage of bladder | **Suprapubic cystotomy to allow drainage of bladder | ||
*Bladder Rupture | *Bladder Rupture | ||
**Extraperitoneal | **Extraperitoneal | ||
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**Any pt with external genitialia trauma w/ hematuria, urinary retention or dysuria requires a retrograde urethrogram | **Any pt with external genitialia trauma w/ hematuria, urinary retention or dysuria requires a retrograde urethrogram | ||
==Source== | |||
Harwood-Nuss | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category:GU]] |
Revision as of 16:24, 24 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
- Grade III: Corticomedullary junction laceration
- Operative management
- Grade V: Shattered kidney, thrombosis of renal artery, avulsion of hilum
Diagnosis
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!
- Extraperitoneal
- 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
Source
Harwood-Nuss