S21C262 - Genitourinary trauma

Question 1

Mechanisms of GU injury

Answer 1

• most common blunt injuries are: MVC, falls, assaults, sports injuries
• most common penetrating: GSW, stab

-children are more prone to GU injury than adults

Question 2

Indications for imaging of GU in trauma:

Answer 2

• gross hematuria (or any hematuria if penetrating trauma)
• BP 50 RBC on u/a
• deceleration injury
• other intra-abdominal or intrapelvic injuries

Question 3

Renal injuries and mgmt:

Answer 3

• grade I-III can often be handled non-operatively
• absolute indications for OR: life-threatening hemorrhage from renal injury, expanding/pulsatile/non-contained retroperitoneal hematoma, renal avulsion injury

-complications: delayed bleeding can occur up to 1mo after injury (AV fistulas occur in 25% of grad III, IV lacs) - urinoma can occur weeks to years after - perinephric abscess - HTN from renal artery injury

• for pts with isolated trauma and microscopic hematuria and no indications for imaging: d/c home and no heavy lifting or strenuous activity x2w until resolution of hematuria
• gross hematuria needs admission
• hematuria with normal imaging (renal contusion) can be d/c home
• pts with subcapsular hematoma can be d/c home with f/u in 24h
• grade II or higher, admit under surgeon

Question 4

ureter injuries

Answer 4

• only 70% of ureteral injuries will have hematuria, therefore absence of hematuria does not rule out ureteral injury
• w/u: u/a, IVU, CT, retrograde peylogram
• tx: stent, repair, surgery

Question 5

Bladder injuries

Answer 5

• 80% are associated with pelvic #
• occur in 2% of blunt abdo trauma
• higher risk for intoxicated pts b/c bladder distended
• extraperitoneal rupture is most common (55%), then intraperitoneal
• intraperitoneal always require srugerical exploration
• extraperitoneal can potentially be managed with bladder catheter drainage (will heal in 1-3w), give prophylactic Abx

-complications: ascites, abscess, peritonitis, sepsis, fistula, neurogenic bladder, impotence

Question 6

urethral injuries

Answer 6

• classified as posterior or anterior
• posterior are in the membranous and prostatic urethra, usually related to blunt trauma from deceleration, often have a pelvic #
• anterior are anterior to the membranous urethra, from trauma to the perineum, blow to bulbar segment, straddle injury, can occur int he penile urethra from penile #, can result in strictures
• female urethral injuries usually present with PV bleeding

Question 7

Genitalia injuries

Answer 7

• penile #: rupture of the corpus cavernosum in an erect penis, crack is heard, pain, immediate detumescence, swelling, discoloration and deformity
• traumatic dislocation of the testicle
• testicular rupture: disruption of the tunica albuginea, tunica vaginalis fills with blood that appears as a large, blue tender scrotal swelling
• investigate with color doppler u/s
• traumatic epididymitis can occur a few days after a blow to the testis, treat as per nontraumatic epidid.
• all penetrating trauma to penis needs surgical opinion

-zipper injury - cana try mineral iol and lidocaine infiltrationto free the penile skin or try wire-cutters to bring the zipper apart