Genitourinary Trauma
INTRODUCTION
The “ABCs” of trauma should be followed prior to investigation of a specific GU injury.
Injuries to the genitourinary system may be associated with blunt or penetrating trauma to the flank, abdomen, or pelvis, or they may occur as a result of rapid deceleration, such as a fall from a significant height.
Trauma involving the ribs and pelvis may be associated with important injuries to the kidney and bladder, respectively, and these may be occult on initial presentation.
A spontaneously voided specimen of urine should be obtained from all patients with blunt or penetrating injury to the pelvis, abdomen, or flank.
Patients unable to provide a specimen should be catheterized, unless urethral injury is suspected.
SPECIFIC DISORDERS
Urethral Injuries
Urethral injuries occur much more frequently in men, and the treatment is more complex, so this section focuses on men with urethral injury.
Urethral injuries can be split into two groups: anterior and posterior injuries.
Posterior urethral injuries are the more serious of the two and occur in the membranous or prostatic portion of the urethra.
Posterior urethral injuries usually occur as a result of major trauma that causes pelvic fractures.
Anterior urethral injuries commonly result from a direct blow to the perineum, such as a straddle injury.
The following signs suggest urethral injury:
Spontaneous oozing of blood from the distal urethra (implying that injury is below the urethral sphincter)
Scrotal, perineal, or anterior abdominal swelling secondary to extravasated blood and urine
A superiorly displaced prostate or a pelvic hematoma on rectal examination
Significant perineal or external genitalia trauma, suggesting a “straddle type” injury
Diagnosis
If a urethral injury is suspected, then an emergency retrograde urethrogram should be obtained before instrumentation (Foley catheterization) of the urethra and will demonstrate extravasation of dye if urethral disruption or laceration is present.
This is performed by injecting 10 mL of water soluble contrast into the urethral meatus and then obtaining radiographs to determine if extravasation is present.Related posts:
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