GU Trauma - K. Dardashti /R. Yakobi

KIDNEY- Overall, kidney is most commonly involved in GU trauma.

 

Classification:

Type I   contusion

Type II  laceration

Type III fracture

Type IV vascular involvement/Shattered kidney

Penetrating  injury:

1. regardless degree of hematuria  every pt needs study if injury is in the renal vicinity.

Blunt injury:

    1. study needed if gross hematuria

    2. study needed if microscopic hematuria in pt with unstable VS

    3. study needed in all pediatric patients with microscopic hematuria need imaging study

    4. no study for dynamically stable pts and microscopic hematuria. This group of pts must  have study if  their hematuria does not resolve in few days. Yet, study is needed in the ER if pt has microscopic hematuria, stable VS but blunt trauma was 2ry to rapid-deceleration injury (fall from height, baseball bat).

Diagnostic tools:

    1. UA - microscopic hematuria in the trauma setting is considered when more than 5 RBC per hpf are present (normal person may contain 3 RBCs). First urine must be examined to avoid dilution effect.

    2. CT -gives staging of injury. Do it only in stable pts. It is more accurate than IVP.

    3. One shot IVP - when pt is unstable and STAT OR is considered. One can do it in the OR. Inject 150 ml (2ml/kg) contrast solution and get an abdominal Xray after 5 - 10 min.

    4. Angio - only for stable pts. Embolization of  bleeding source is possible.

Management: 

1.   Except Type I, all other injuries require GU evaluation for admission.

 

 

BLADDER:

 

    1. Blunt injury is the most common. Look for pelvic fx  and urethral injury.

    2. Hematuria is universally present. Also pain and  anuria.

    3. For diagnosis do Cystography with Foley or suprapubic catheter. This is done by injecting "scout" contrast dose of  100 ml to r/o  big extravasation and then 300 ml to distend bladder and r/o minor tears. This is almost  100% sensitive

 

URETHRA:

 

    1. 2ry to blunt injury s/p MVA

    2. pt unable to void, hematuria, blood at the meatus, high riding or boggy prostate, hematoma to scrotum/penis.

    3. for diagnosis do Retrograde Urethrography. Insert Foley about 1-2cm. Inject 30ml contrast. Shoot Xray. Do not attempt placement of the whole Foley catheter.

    4. penile artery integrity is assessed by Doppler.

 

TESTICULAR INJURY:

 

    1. to R/O  injury  get  US.
       
    2. penetrating injury deep into dartos, requires surgical exploration.

 

PENILE FX:

 

    1. pt c/o swelling. Frequently refers to  hearing "POP" sound

    2. hematuria and inability to void are present if urethral injury is present,  thus this has to be ruled out with Retrograde Urethrogram

    3. immediate surgical repair

 

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