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Trauma! Genitourinary Injuries

Most genitourinary injuries can safely undergo delayed repair once the patient has been stabilized and other injuries dealt with. Renal pedicle injury is an exception...

Even severe injuries such as renal artery injury or ureteropelvic disruption may present without haematuria. About 5% of renal injuries and up to 20% of renovascular injuries lack haematuria. Nevertheless, in general the greater the degree of haematuria the greater the risk of significant intra-abdominal injury (including non-urinary tract structures).

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  ED Management of GU & Pelvic Trauma - Dr. Gibbs

10% of injuries involve GU tract. May not be evident during the intial exam. Hematuria is most important sign of GU injury!

 Genitourinary Trauma: Presentations, Evaluation, and Management Updates

The clinical presentation of GU trauma is classically taught as pain with voiding, inability to void, blood at the urethral meatus, perineal hematoma, and a high riding prostate. These classic signs and symptoms are suggestive of urethral disruption, though the absence of these signs does not exclude injury to the urethra.

Articles of Interest

EM@3AM: Bladder Rupture

It is a primarily extraperitoneal organ. The dome of the bladder is lined by the peritoneum and is also the weakest part of the structure. Bladder injuries are uncommon, occurring in approximately 1.6% of blunt trauma. Injuries are primarily caused by blunt trauma and are most often associated with pelvic fractures. Penetrating trauma and iatrogenic injuries do occur but are much less common. Motor vehicle accidents account for the overwhelming majority of bladder rupture presentations.

Emergency Management of Renal and Genitourinary Trauma: Best Practices Update

For trauma patients in the ED, life- and limb-threatening injuries take priority, but renal and genitourinary injury can have long-term consequences for patients, including chronic kidney disease, erectile dysfunction, incontinence, and other serious problems.

Getting a Grip on Penile Fractures

Penile fracture is a rare urological emergency requiring prompt surgical intervention to preserve sexual function. Complications secondary to penile trauma include urethral injury, permanent erectile dysfunction and a deformed penis.

Penile Injuries

Penile fractures are one of the most common injuries of the penis and are often sustained by vigorous sexual intercourse. ED management of penile fractures includes pain control, swelling reduction with ice, Foley placement once a urethral injury is ruled out and emergent urology consult for operative intervention. Zipper injuries occur most frequently in young, uncircumcised males. Mineral oil is the best way to try to free a zipper-trapped penis. If unsuccessful, try bisection of the median bar of the zipper. Penile strangulation occurs by the self-placement of constricting rings and can end up causing penile necrosis or amputation if the constricting object is not promptly removed.

Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians

Any type of trauma can affect the urethra; however, specific injury patterns affect the urethra at higher incidence. The majority of urethral trauma is caused by blunt injury, penetrating injury, and/or iatrogenic injury. Most major urethral injuries are due to blunt trauma caused by mechanisms such as motor vehicle collisions, kicks, or falls.

Urethral Injury

Urethral injury is a relatively rare medical condition accounting for less than 1% of all emergency department visits in the United States. Injury patterns vary and encompass urethral crush, bruising, laceration, and transection. Urethral injuries are never life-threatening, but if left untreated can cause significant morbidity. While most injuries are iatrogenic, traumatic etiologies often caused by high energy mechanisms certainly do carry mortality threats. The injury extent and anatomical location are formative in the development of a management plan.

Urine Trouble: Tricky Bladder Mimics

Bladder scans are essential to diagnosis, management, and treatment of emergency medicine patients. FAST and RUSH exams1 have incorporated bladder ultrasound to rapidly assess for free fluid in a hemodynamically unstable patient. For infants presenting with fever, POCUS can be used to assess bladder volume to facilitate timing of catheterization. For patients presenting with low urine output, POCUS can help differentiate low urine volume versus obstructive uropathy. Knowing the relevant landmarks, typical bladder shape, and mimics can help accurately identify pathology.