Genitourinary Trauma

Posted by e-Medical PPT Thursday, October 25, 2012
GU trauma, because of its very often non life-threatening injuries and its subtle presentation, is very often overlooked and poorly recognized in the emergency departement. However, approximateley 10-20% of all injured patients have some kind of GU involvement which can lead to very debilitating long term sequalae such as incontinence and impotence.
Although the more life-threatening injuries of the primary survey must be addressed first, we must be alert to the clues pointing to the presence of GU injuries.
So in the OVERALL management of all trauma patients, it is very important that we have a complete understanding of GU injuries, how to deal with it and how it can impact on patient outcome.
Being good at managing trauma patients doesn’t only mean being good at putting chest tubes.

Urethral Trauma
Almost exclusively in male
Significant morbidity
Stricture
Incontinence
Impotence
If unrecognized:
Converting partial to complete tear
Inaccurate assessment of U/O
Foley catheter implication

Female: severe pelvic fracture and bony displacement along with lacerations through the bladder neck and vagina are present in cases of urethral trauma.
Morbidity: 15% (stress) incontinence in this study by Andrich: Men from 19-51! In previous studies, depending on the method used to repair the urethra, the rate of Incontinence/impotence is up to 70%, needing RE-operation to correct the problem.
Journal of Urology, 1996 Oct.: Stricture:49-97%. Impotence:0-36%. Incontinence: 0-21%. (Impotence and incontinence is a complication of procedures with less strictures.
…and as you learned in your ATLS, Foley catheter is C.-I. if you suspect urethral trauma.

Clinical Features
Gross hematuria in 98%
Inability to void
Blood at urethral meatus
Pelvic / suprapubic tenderness
Penile / scrotal / perineal hematoma
Boggy / high-riding prostate/ ill-defined mass on rectal examination

Diagnosis_Retrograde Urethrogram
Pretest KUB film
Supine position
Injection of 25ml of water-soluble contrast
Different techniques
X-ray when 10ml left and after 25ml
Post-voiding x-ray

Bladder Trauma
Extraperitoneal
Most common
Pelvic fracture in 89-100%
Bladder rupture in 5-10% of all pelvic fracture
Intraperitoneal
Extravasation of urine in abdomen
Sudden force to full bladder
Associated injuries +++ ----->Mortality (20%)
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