Urogenital Trauma

Question 1

GENERAL APPROACH to suspected lower urogenital trauma:

Answer 1

Ie. Bladder, urethra

CLUES:
- Frank haematuria
- Swelling to penis, testes, ant abdo wall
- Blood at meatus
- Perineal haematoma
- High-riding prostate
- Pelvic free fluid on FAST
- Unable to pass IDC

APPROACH:
- Avoid IDC
- Obtain lifesaving scans first (so not obscured)
THEN, *retrograde assessment of structures:

• Retrograde urethrogram
  IF URETHRA OKAY:
• IDC and cystogram
  IF NOT: SPC

Question 2

Classification and management of bladder injuries:

Answer 2

Classified as:
1- Contusion
–> conservative

2- Intraperitoneal rupture:
Compressive force
–> Laparotomy

2- Extraperitoneal rupture
Laceration from pelvic #
Into testes, penis, anterior soft tissues
–> IDC 10-14 days

Amoxy/gent prophylaxis

Question 3

What is a ‘high riding prostate’:

Answer 3

Unable to reach/ feel on DRE, or very high

Indicates urethral injury

Associated:
-Retention
-Perineal haematoma
-Meatal blood

DO NOT INSERT IDC IF ANY OF ABOVE. Urethrogram first.

Question 4

Diagnosis of ureteric injury:

Answer 4

Difficult!

But, VERY rare with blunt trauma.

MOST are delayed diagnoses (weeks)

CT contrast delayed images
Or, excretory urography (better)

Question 5

Testicular rupture

Answer 5

Breach of tunica albiguinea (capsule) –> extrusion of seminiferous tubules/ sperm etc.

Ecchymosis

Urgent surgical exploration (USS only if equivocal)
OT within 72hours (90% salvage)

If out, replace into scrotum.

Early surgical exploration massively reduces chance of orchidectomy- 10 vs 45%!

Question 6

Approach to traumatic haematuria:

Answer 6

Don’t always get haematuria, even with major renal tract injuries

_________

If SYMPTOMATIC or MACROSCOPIC, always scan.
–> CT with contrast + delayed phase PLUS cystogram
CT alone not great for bladder
- +/- dedicated retrograms

If ASYMPTOMATIC with MICROSCOPIC, can leave alone.
–> GP for repeat dip 1 week
- likely renal contusion: