Genitourinary trauma

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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